Skip to main content

Full text of "Harvard medical alumni bulletin"

See other formats

AUTUMN 2001 








Neurosurgeon Benjamin Carson 
celebrates the power of 
perseverance in medicine 

,ans Zinsser (1878-1940), 
an HMS professor who helped 
lead in the fight against 
typhus, wrote in his 1 935 
book Rats, Lice and History, 
"Infectious disease is one of 
the few genuine adventures 
left in the world." 

AUTUMN 200] • V O L U M I 75. NUMB E R 2 





Pulse I 

The Class of 2005; the State of the 
School address; an exhibit of incunabula; 
the medical curriculum online; alumni 
provosts, a new AIDS division; and the 
Academy's first leader 

Bookmark 10 

A review oi .4 Question oj Intent: A Great 
American Battle with a Deadly Industry 

by Elissa Eh 

Bookshelf 11 

Benchmarks 12 

Common aspirin reveals a mechanism 
of insulin resistance. 
by Carol Cruzan Morton 

Class Notes 56 

InMemoriam 59 

Joseph Ganiella. \\ lUiam \ '. McDermott, and 

Carter R. Rowe 

Obituaries 62 

The Long and Winding Road 14 


Great Expectations 18 


Renewing an Ancient Covenant 24 


Becoming a Jedi Isn't Easy 26 



Reinventing Ourselves 

b) I O M R E V N OLDS 

Tasting Our Own Medicine 


Digital Medicine 


The Well-Attending Physician 36 


Drawing the Lines 39 

In | S E P H B . MARTIN 

Talking About a Revolution 42 



Reports from the Classes 44 

Cover photograph by Liza Green 

Harvard Medical 


In This Issue 


quarterly publication schedule, this issue of the Bulletin recounts 
the thoughts and emotions of Class and Alumni Days, 2001. As a 
rule, such a lapse of time does little to stale our contents. The sen- 
timents at these annual events tend toward the enduring, the verities toward 
the decidedly eternal. Speakers express their vision of the future, but with a 
focal length extending well beyond the end of the year. This fall, of course, has 
felt much different. None of those who spoke last June could have anticipated 
quite how the world would seem when their words appeared in print. 

Our previous issue, with its special report on HMS in the Second World 
War, might seem closer than this one to the mood engendered by the terrorist 
attacks. But that issue was planned much earlier. At the time we could not and 
did not intend any comparison between September 11, 2001, and December 7, 
1941. But comparisons there must be. As I write, medicine is again moving to 
the front line and the front pages in a new sort of warfare, which threatens to 
permeate our lives for years to come. After a devastating few days in which 
physicians had little to offer because there were so few victims left wounded 
by the destruction of the New York towers, public health and medical science 
have become the second front of this new war as anthrax is being disseminated 
through the mails. 

Future issues of this publication must in their modest way begin to take 
account of the new world disorder that the recent events portend. The inter- 
national reality is that a fellow physician is one of the most important leaders 
of al Qaeda, and another has for years been deeply implicated in the atroci- 
ties committed in the former Yugoslavia. Is this coincidence? Is it paradox? 
Or does it say something about the way medicine as a force for moderniza- 
tion will become entangled in the worldwide struggle to contain or reverse 
the forces of modernity? 

This issue, then, is a glimpse of the past, of a couple of warm spring days 
when the world seemed quite a bit safer and the task of medicine could be 
outlined in largely positive ways. Nothing that has happened since last June 
should be allowed to undo the remembered warmth or the optimism of those 
days. But our annual celebration of medicine and physicians as a benign and 
progressive social force may for some years become a more complicated and 
sadder event, as we seek to find our way through the social and cultural mine 
fields that, with the best of intentions, we all have entered. 



William Ira Bennett '68 


Paula Brewer Byron 


Beverly Ballaro, PhD 


Susan Cassidy 


Elissa Ely '8 


Judy Ann Bigby '78 
Rafael Campo '92 

Elissa Ely '88 

Atul Gawande '94 

Robert M. Goldwyn '56 

Perri Klass '86 

Victoria McEvoy 75 

James J. O'Connell '82 

Nancy E. Oriol 79 

J. Gordon Scannell '40 

Eleanor Shore '55 

John D. Stoeckle '47 


Laura McFadden 


Paul J. Davis "63, president 
Mitchell T. Rabkin '55, president-elect 1 
Eve |. Higginbotham 79, president-elect 2 

Paula A. Johnson "85, vice president 

Maria C. Alexander- Bridges "80, secretary 

Cecil H. Coggins '58, treasurer 


Rafael Campo '92 

Barbara J. McNeil '66 

Gina T. Moreno John '94 

DeWayne \1. Pursley '82 

Laurence J. Ronan '87 

Mark L. Rosenberg 72 

Nanette Kass Wenger '54 

Francis C. Wood, Jr. '54 

Kathryn A. Zufall Larson 75 


Daniel D. Federman '53 


Nora N. Nercessian, PhD 


Joseph K. Hurd '64 

A*H (M 

The Harvard Medical Alumni Bulletin is 

published quarterly at 25 Shattuck Street, 

Boston. MA 02115 ' by the Harvard 

Medical Alumni Association. 

Phone: (617) 384-8900 . Fax: (617) 3S4 8901 

Email: bullctin(" , 

Third class postage paid at Boston, 

Massachusetts. Postmaster, send form 3579 

to 25 Shattuck Street. Boston, MA 02115 

ISSN 0191 7757 . Printed in the U.S.A. 





Paradise Lost 

The spring issue ol the Bulletin on 
"Unsung Heroes" was very interest 
ing — and practical, as it pointed to 
avenues of service tor retired physicians 
such as myself. 

In the same issue, the account that 
Carl Taylor '41 wrote about his visits to 
Nepal ("The Last Home ol Mystery") 
brought back many memories. Hie leader 
ol the 1949 expedition he describes — 
Robert "Hullu" Fleming, Sr. — taught us 
biology at Woodstock School, which was 
run by the American Board of Missions 
in the Himalayas just west of Nepal. Of 
course, we were regaled with the adven 

tures of the expedition. Carl Taylor was 
already a legend in India. 

For years, we collected specimens ol 
plants, insects, and birds for Robert to 
send to the Field Museum of Natural 
History in Chicago. He also encouraged 
us to hike into the back ranges ol the 
Himalayas to collect specimens and to 
experience the thrill of adventure. The 
crown prince ol Nepal and some of his 
siblings had started attending Wood- 
stock, and I believe this was the lexer 
that opened the door to that country. 

A year or two later, Robert's wife, 
Bethel, who was the school doctor, 
joined him on a second expedition. She 

Striking Gold 

The Bulletin recently received nods of recognition for editing, writing, and 
design. Folio: Magazine awarded the Bulletin its Gold Medal for Editorial 
Excellence in the Healthcare/Medical category. The Association of American 
Medical Colleges presented an Award of Distinction to Beverly Ballaro, 
associate editor, for her article "When HMS Went to War," which appeared 
in the Summer 2000 issue. And the Bulletin received an honorable mention 
from the Ozzie Awards for best use of black-and-white photography. 

started a hospital in Katmandu. When 
the Flemings went on sabbatical, the 
hospital was run by many volunteers, 
including my mother, Dorothy. Over the 
years I have met several doctors who 
have gone to that hospital, such as Ray- 
mond Stannard and Gordon Mack. It 
would be interesting to know whether 
the hospital is still functioning. 

The opening of Nepal was inevitable, 
and from Dr. Taylor's account, probably a 
mixed blessing. In view ol the recent 
tragedy involving the Nepalese royal fam- 
ily, one has to wonder whether some ol 
them were the students who attended 
Woodstock more than 50 years ago. 

[OHN C HAL KO '6o 


Start Kidding Yourself 

I have been a practicing pediatrician lor 
more than 16 years. As I was listening to 
the Alumni Day speeches on physician 
renewal, I thought about an 18-month- 
old girl I had seen recently. This exu- 
berant toddler had scampered around 
my office, filling it with the sheer joy of 
being. She suffers from chronic renal 
failure and had at one point even been 
"dead" for more than 40 minutes. But in 
my office she was charged with an 
energy that allowed her to overcome 
her disabilities. 

We all have that joy, still, within 
us, buried beneath research, journals, 
fatigue, responsibility, and worldly 
cares. Seek and connect with your inner 
child daily. If we run and skip, throw 
temper tantrums (at HMOs, for instance), 
and are just happy, allowing ourselves to 
wonder and play, then we shall be 
renewed. We can look to children to 
teach us this important lesson 



The Bulletin welcomes letters to the editor. 
Please send letters bx mail (Harvard Medical 
Alumni Bulletin, 25 Shattuck Street. Boston, 
Massachusetts 02115): fax (617-384-8901): or 
email ( Letters may 
he edited for length or clarity. 




The Class of 2005 

After a welcome from the deans, the 
incoming Class of 2005 took part in 
the traditional White Coat ceremonies, 
which marked the beginning of their 
journeys as doctors. 

The entering class consists of 80 men 
and 84 women. The number of minority 
entering students remains strong, with 
seven Asians and Pacific Islanders, 27 
African Americans, four Mexican Ameri- 
cans, one Native American, and two 
Puerto Ricans. The youngest entering 
medical student is 21 years old, the 
oldest is 32, and the median age is 23. 

Thirty-three U.S. states are represented 
in the class. California leads with 28 
students. Massachusetts is next, with 
22, followed by New York with 1 8, 
and New Jersey with nine. There are 
five international students, including one 
each from Canada, Germany, Greece, 
Italy, and Slovakia. 

About 23 percent of the class (37 
students) graduated from Harvard Col- 
lege. The next highest numbers come 
from Yale (ten students), Princeton (nine 
students), Stanford (eight students), and 
MIT (seven students). Science majors 
make up 68 percent of the class, while 
1 3 percent majored in humanities and 
5 percent in social sciences. Nine 
percent graduated with double majors. ■ 

GETTING A MED START: First-year students 
Kedar Mate, Hans Ackerman, and Jacinda 
Mawson attend the White Coat ceremony 
of the Cannon Society. 

The State of the School 


a theme of HMS Dean Joseph 
Martin's fourth annual State 
of the School address, which 
he delivered to the HMS community in 
late September. Illustrating his talk 
with images of the many steel and con- 
crete bridges around the Longwood 
medical area, the dean gave a progress 
report on the equally abundant institu- 
tional bridges connecting the School's 
components and reaching out to affili- 
ated hospitals, other Harvard schools, 
and partners in the neighborhood, the 
city, and around the world. 

Building Bridges 

Martin's aim, he said, was "to show that 
the spirit of cooperation and collabora- 
tion is continuing, to provide evidence of 
progress, and to mark honestly areas of 
concern where further work is needed." 

Martin opened by displaying an aeri- 
al shot of Boston's new signature land- 
mark, the Leonard P. Zakim Bunker 
Hill Bridge over the Charles River, and 
lauded Zakim's work in interfaith rela- 
tions as well as his lesser- known advo- 
cacy for terminally ill patients at the 
Dana-Farber Cancer Institute. 

The most visible evidence of Martin's 
collaborative drive is the new research 
building that will anchor the North 
Quad across Longwood Avenue to the 
original 1906 Quad. One of the largest 
projects ever undertaken at Harvard 
University, the building is on schedule, 
below budget, and slated to open in the 
fall of 2003. 

"The remarkable thing from my per 
spective is how flawless the planning 
has been in determining who will use 
the new building and what we will do 
to grow other programs throughout the 
Quad," Martin said. The Departments 
of Genetics and Pathology will move to 
the new building, which will also house 
the newly created Harvard Partners 

Program in Genomics and several basic 
research programs of Brigham and 
Women's Hospital and Beth Israel Dea- 
coness Medical Center. At the same 
time, the department chairs have iden- 
tified five priority research areas to be 
expanded in the South Quad space 
freed up by the move: systems biology; 
computational biology; parasitology; 
imaging; and structural biology 

Expanding Research 

Martin highlighted several items of note 
on the research front. Five core pro- 
grams and their leaders have been 
determined for the Harvard Center for 
Neurodegeneration and Repair; Centers 
for Translational Neurology Research, 
Brain Imaging, Molecular Pathology, 
and Computational Analysis, as well as 
a robotics facility. The Harvard Institute 
of Proteomics is working to establish 
a gene expression repository for all 
human and model organism genes and 
to make these publicly available through 
the FLEXGene consortium. The Dana- 
Farber/Harvard Cancer Center has 
two Specialized Programs of Research 
Excellence (SPOREs) funded by the 
National Cancer Institute, in breast and 
skin cancers. And a new Division of 
AIDS is being formed with faculty from 
all the major affiliates and in collabora- 
tion with the Harvard School of Public 
Health and the Harvard School of Den- 
tal Medicine. 

Teaching Medicine 

Turning to medical education, Martin 
announced several appointments; George 
Thibault '69 was named director of the 
fledgling Academy at Harvard Medical 
School, heading up a group of 18 founding 
members. And two new society masters 
were named; Gordon "Buck" Strewler '71 
for the Cannon Society and Augustus 
White III for the Holmes Society. 


A New Exhibit of the Very Old 

The Francis A. Countway Library of Medicine has 
embarked on an ambitious project to describe and cat- 
alog fully its holdings of incunabula, which are the very 
first examples of books, pamphlets, and broadsides print- 
ed with moveable type in Western Europe. The library is 
also making online descriptions of these items available 
to scholars and researchers for the first time. To com- 
memorate these efforts, the library is hosting an exhibit 
on incunabula, which are also sometimes referred to as 
"fifteeners" from their appearance in the fifteenth century. 

The Countway Library, with more than 800 items, 
holds the largest collection of medical incunabula in 
the country and one of the finest collections of its kind 
in the world. The famous names and rare editions of the 
great early works in medicine are all well-represented. 
Books on virtually every facet of medical knowledge 
are included, along with works on pharmacy, botany, 
natural history, witchcraft, alchemy, astrology, poetry, 
and philosophy. 

The Fifteeners exhibit allows a glimpse of these rarest 
of printed medical works. Some of the more unusual 
items on display are Thucydides' description of the fifth- 
century plague at Athens, the first German edition of 
the lavishly illustrated Nuremberg Chronicle, a 1494 

almanac predicting solar and lunar eclipses, the first full-length illustration of a 
muscle dissection, the first printing of a medical treatise in Hebrew, and the first 
Latin edition of the Hippocratic Oath. 

The exhibit will be on display through April 1 , 2002. For more information, visit, or contact Jack Eck- 
ert at 617-432-6207 or jack ■ 

inNc ipir TracTarus dr uirtutibiis hcrbarnm 
flumorumegenrium appotecas refurauttum 
occaliofK ilia. quia neccefTaria ibidem ad cci 
pus fgru5 fpecranria funt cara fimplici a S£ ci. 
. . poiita .numnnf qi plunmis comparanda . fed . 
ptrftmrrirns mca non fe diuenic fed ad ca que in prim - 
(is loci's oris film's ac pra-is inumiunt .cpop prefenria 
pus hurnanu egrum feu ncurru ad corpus faini reduci , , 
terirrrfianrifolein' medico Arnold! deiioua uilla tic iqiiie 
re in amphorf mis fats. C115 quis potent mederi fimplid. 
b' fruftra K dolofe medicamia ppofita querit ille. Ait eria 
A jicciu fedo 4. Mediae limplices habit opanones 
uel es Si pticulares.Et cu penes corp' humarj plur? 1 co 
curru aifF fc5 circa pfecle fanii acV pferuariti'n-^f Tin' 
e arc j fenfibi'liter leUi5 *8P curiariu' iducend' c.circa ue 
ro iinfibilif lefu actV-pferuanu' feu refupriu' neceTari'e. 

The Countway 
Library exhibit on 
medical incunabula 
includes many rare 
and beautiful exam- 
ples of the first print- 
ed matter. Pictured 
above is a woodcut 
from a book on the 
medicinal uses of 
common herbs; to 
the right is an illus- 
tration from a popu- 
lar compendium of 
plant and herb lore. 

\Lirtin displayed the front page of 
the MyCourses website for students 
and faculty and credited John Halamka, 
the new associate dean of educational 
technology, for his efforts in creating 
the site. Martin then referred to the 
new Student Affairs Office on the third 
floor of the Gordon Hall of Medicine, 
explaining that "the idea here is to 
encourage students to be more aware of 
and available to us in that remote site ol 
the Quad." 

The dean went on to recognize the 
efforts of Harvard Medical International 
in building global bridges. A milestone 
for Harvard Medical International this 
year, he said, was the Health Care East 
and West Conference in June, which 
brought 600 physicians from China, "the 
largest single group of people to leave 
the mainland in the last 50 years, except 
for the Olympics." He added that the 
event represented a historic first step to 
building a bridge of dialogue between 

physicians in the United States and their 
counterparts in China. 

After calling for a moment of silence for 
the victims of the September 11 terrorist 
attacks, Martin announced that an open 
forum for the HMS community would be 
held on the one- month anniversary of the 
tragedy. He closed by reminding the audi 
ence of the HMS mission: to create and 
nurture a community of the best people 
committed to leadership in alleviating 
human suffering caused by disease. ■ 




The Medical Curriculum Goes Digital 

PORTAL TO THE FUTURE: Griffin Weber (left) and John Halamka led students and 
faculty in taking the medical curriculum to the next level. 


the Harvard School of Dental 
Medicine have launched the 
newest version of their online 
curriculum, one that provides electronic 
access to the complete course material 
for all four years. The eCurriculum, as 
it is known, is the brainchild of John 
Halamka, HMS associate dean of educa- 
tional technology, who, together with a 
team of programmers and educators, 
worked for eight months to ensure that 
the transition from pen and paper to key 
board and screen would be completed by 
the start of the fall semester. 

Students gain access to the eCurricu- 
lum through the aptly named web portal 
MyCourses. "Our goal was to provide 
a single destination for all electronic 
resources students would need," Halamka 
says. The portal lives up to expectations. 
A tew mouse clicks can take students to 
handouts, casebooks, histology slides. 

and, via streaming video and endoscopy, 
deep into the human body itself. 

From the student's perspective, the 
beauty of the system is its very simplici 
ty Everything is available from any com- 
puter, anywhere, anytime. Because the 
School knows which courses students 
have elected, each portal comes with a 
tailor made calendar; if a student wants 
to find out what she will be doing in 
mid February, for example, it's all there, 
just a click away. 

Student input was, of course, crucial 
to the project. As luck would have it, 
while Halamka and the faculty were 
brainstorming about the eCurriculum 
last winter. Griffin Weber, a first year 
student, was independently working on 
his own website for classmates in Health 
Sciences and Technology, building some 
of the features that would eventually be 
used for the MyCourses portal. When 
Halamka saw what Weber had done, he 

immediately recognized that it was 
exactly what he wanted. Soon the two 
projects merged. 

Professors, too, have a MyCourses 
portal, but theirs comes with editing 
privileges. They can upload course con- 
tent and post announcements — all from 
home, if they wish. Faculty members 
have three main utilities: CourseEditor, 
which allows the content of an entire 
course to be uploaded in advance; Case- 
Builder, which enables faculty to post 
scenarios based on encounters with real 
patients; and the ResourceBank, a repos- 
itory for teaching aids that can be used 
for any HMS course. 

Halamka was not satisfied with tradi 
tional portals, so he made everything 
mobile. With the help of ArcStream 
Solutions, Inc., MyCourses web content 
can now be transferred to personal digi 
tal assistants, so students and faculty- 
can have their calendars and announce- 
ments in their pockets, right where they 
need them. This will be especially useful 
to third- and fourth years, who arc often 
off campus and may not have computer 
access. In addition, the second floor of 
the Tosteson Medical Education Center, 
which houses the student societies, is 
now equipped with infrared data- trans 
fer capability, allowing students to syn 
chronize their PalmPilots with the touch 
of a button. 

The handheld devices also offer their 
own suite of utilities, some particularly 
suited to clinical settings. These 
include drug and toxicology databases, 
such as ePocrates and Micromedex, 
which can help doctors make treatment 
decisions on-site, and PatientKeeper, 
which allows students to record 
patient information on their rounds 
and consult their data later if the need 
arises. Of course, security is a major 
concern, so Halamka's team has gone to 
great lengths to ensure that access is 
limited and patient confidentiality 
remains uncompromised. ■ 


Once and Future Provosts 


future provosts of Harvard 
University arc graduates ol 
Harvard Medical School. 
Harvey V. Fineberg 71, who resigned 

as provost last summer, will become the 
seventh president of the Institute of 
Medicine (IOM) in July 2002. Fineberg 
was dean of the Harvard School of Public 
Health for 15 years before serving as 
Harvard provost from 1997 to June 2001. 

The 1.429 member Institute ol Medi 
cine was chartered by the National 
Academy of Sciences to enlist distin 
guished members ol the health profes- 
sions in examining health-policy mat 
ters. IOM advises the government on 
issues such as vaccine safety, health 
care delivery and quality, nutrition stan 
dards. cancer preven- 
tion and management, 
and military and vet 
erans' health. 

Kenneth Shine '61, 
the current president 
of the Institute of 
Medicine, noted, "Har 
vey Fineberg combines 
a rich academic leader 
ship experience with 
a continuing commit 
ment to and involve 
ment in the health ol 
the public. He is an 
outstanding choice." 

"To meet the public's health needs 
and to fulfill the promise of science for 
health have never been more compelling 
social goals," Fineberg said. "Thanks to 
the work of Ken Shine and many others, 
the Institute of Medicine is better pre 
pared than ever to accomplish these 
objectives. It is a privilege to be named 
as president-designate of the IOM, and I 
relish the opportunity to lead this vital 
and dynamic institution." 

Helping to lead another dynamic 
institution will be Steven Hyman '80, 
director of the National Institute of 


alumni — the outgoing Harvey 

Fineberg (left) and the incoming 

Steven Hyman — will have served 

as Harvard provosts. 

Mental Health, who becomes the I'm 
versity's new provost in December 2001. 
As provost, Hyman will be responsible 
for academic planning and policy matters 
of high priority to the University, with 
an emphasis on activities that extend 
across several Harvard faculties or other 
w ise involve collaboration and change. 

Hyman is no stranger to Harvard. He- 
spent 20 years at HMS. as both a student 
and a professor of psychiatry. He served 
as deputy director ol psychiatry research 
at Massachusetts General Hospital from 
1992 to 1996, director of the Division on 
Addictions at HMS from 1992 to 1995, 
and the first faculty director of the Uni 
versity's interfaculty Mind Brain Rehav 
tor initiative from 1994 to 1996. 

In \°96, Hyman took over as director of 
the National Institute 
of Mental Health, 
where he intensified 
efforts to bring togeth 
er molecular biology, 
genetics, neuroscience, 
and behavioral science 
in an integrated way 
to better understand 
mental illness and 
mental health. 

Hyman has focused 
his own research on 
mechanisms of neural 
plasticity in the brain. 
His principal interest has been on how 
dopamine and glutamatc produce long 
term changes in brain function by alter 
ing gene expression in the striatum and 
nucleus accumbens, regions involved in 
the control of motivated behavior and 
implicated in the action of both antipsy- 
chotic medications and drugs of abuse. 

"I am very excited to be returning 
to Harvard," Hyman said, "and to have 
the opportunity to address important 
issues ranging from new ways of cross- 
ing disciplinary bounds to thinking 
about science education for undergrad 
uates." ■ 


The nation's most unique investment 
letter, written & edited 

**The highly regarded Schott Letter 

helps investors cope with emotional 

hang-ups that make for mistakes 

in the stock market. ♦♦ 

Forks, February 1996 

In 1986 Dr. Schott 

recommended the purchase 

of Berkshire Hathaway; will you be 

a reader when he finds 

the next Berkshire Hat haw av? 

24% average returns for 1 2 years 

THE SCHOI I i I ll II.' 


Pi A 1 k, MA 02050 

5110.00 for 12 issues 

(800) 797-9678 

. nrv^Yirmcv\\Yn . 


Carper Diem 

A Rug for Everyd.iv & 1 very Mood 

From Antique Orientals to 
Contemporary, and Everything in Between 


14] Newbury Street 

Boston, MA 02116 

617 262 1529 Validated Parking 






some of the most impor- 
tant advances against HIV 
and AIDS in the 20 years 
since the epidemic began. But until 
now, they have not had a common 
institutional base within the School. 
The new HMS Division of AIDS will 
provide that home and will enhance 
coordination, spur collaboration, and 
open up new avenues for research 
funding, its leaders say. 

"Harvard Medical School has made 
tremendous contributions to dealing 

with the HIV epidemic, but we all 
believe we can do much better still," 
says Bruce Walker, HMS professor of 
medicine at Massachusetts General 
Hospital and the division's first direc- 
tor. "The Division of AIDS is a way to 
help coordinate an accelerated effort to 
address this global health crisis." 

All investigators at the School and 
affiliated institutions who receive 
funding for HIV-related basic or clini- 
cal research — from the National Insti- 
tutes of Health (NIH) or other peer- 
reviewed sources — will be considered 

The HMS Record Against AIDS 

hiv/aids researchers at harvard medical school: 

• Demonstrated a marked decrease in CD4 + T cells in AIDS patients, 
establishing a basis for the impairment of the immune system in the disease; 

• Made the first clinical description of an AIDS-like illness in monkeys and 
demonstrated viral transmission in monkeys; 

• First isolated HIV from semen, providing critical support for the theory that 
HIV is sexually transmitted; 

• First demonstrated in vitro that combination antiretroviral therapy is more 
effective than single-drug therapy in reducing HIV replication; 

• Created the first animal model to study how HIV damages the fetal immune 
system and how prenatal and perinatal transmission can be prevented; 

• Established the critical role of HIV-1 -specific T helper cells in protecting 
against disease progression; 

• Obtained the crystal structure of the HIV-1 gpl20 envelope protein, resulting 
in three-dimensional pictures that reveal how HIV-1 attaches to white blood 
cells and evades the host immune system; 

• Demonstrated that early treatment of acute HIV infection augments immune 
function and allows for spontaneous immune control of the virus after treat- 
ment cessation in some patients; 

• Performed the first effective vaccination in monkeys against a strong virus 
challenge, giving insight into protective immune responses; and 

• Established the cost-effectiveness of highly active antiretroviral therapy 

Division of AIDS Created to Speed Research I 

UNDER A BIG TENT: Bruce Walker directs 
the new HMS Division of AIDS, which 
brings HIV researchers from the School 
and affiliated institutions together under 
one umbrella. 

division members. This group current- 
ly numbers 165 faculty with S75 million 
annually in sponsored research fund- 
ing. The division will combine two 
existing NIH-funded Centers for AIDS 
Research already based at HMS and its 
affiliates into one large unit. The AIDS 
Clinical Trials Unit and the HIV Vac- 
cine Clinical Trials Unit will also 
become part of the division. 

To preserve the collaborative spirit 
that guided the division's creation, 
leadership will rotate among the par- 
ticipating institutions every two years. 
When Walker's term is up in 2003, 
associate director Joseph Sodroski, 
HMS professor of pathology at the 
Dana-Farber Cancer Institute, is slated 
to succeed him as director. 

Raphael Dolin '67, HMS dean for 
clinical programs, helped to establish 
the division and serves as the dean's 
office liaison to the group. He says that 
until now, many AIDS researchers at 
HMS "were collaborating at a consid 
erable distance, when they had equal or 
greater opportunities within the Har- 
vard medical community. This is a way 
to bring them together." 

Walker emphasizes what he calls 
the "stunning" list of advances the 
School's faculty have made against 
HIV. For example, "The key immune 
responses that are thought to be 
important for vaccine development 


were all discovered at Harvard Medical 
School — neutralizing antibodies, cyto- 
toxic T cells, and T helper cells and 
their role in AIDS pathogenesis," he 
says. "What we're trying to do now as a 
division is to build on these and many 
other advances." 

Walker's own research has shown 
that treating patients very early in the 
acute phase of HIV infection can 
change the way their immune system 
sees the virus, induce strong helper T 
cell responses and, in some cases, get 
patients off medicine and allow them to 
control the virus on their own. 

Particularly crucial to advancing 
current treatments. Walker says, will 
be the division's ability to bring basic 
and clinical scientists into close work 
ing relationships. "Because we're seeing 
clinical manifestations of the disease," 
he says, "we're able to think about the 
important biological questions in a dif 
ferent way than someone who is work 
ing in basic science totally divorced 
from the clinical front." 

The division will foster interinstitu 
tional collaboration in education and out 
reach as well as research, Dolin says. It is 
meant to complement the Harvard AIDS 
Institute, which is based at the Harvard 
School of Public Health. Collaborations 
with the institute are already planned. 

A fundraising component to the divi 
sion is also anticipated. "There are a lot 
of people interested in contributing to 
the fight against AIDS, and we think 
the opportunity to contribute to the 
entire Harvard program will be attrac 
five to potential donors," Dolin says. 

A major goal will be to raise the 
resources needed to build "the best HIV 
research center in Africa," in one of the 
areas hardest hit by the epidemic. 
Walker says. The center is envisioned as 
a training ground for Atricans who 
aspire to become AIDS researchers and 
as a platform for studies of antiviral 
therapy in resource poor settings. ■ 

Tom Reynolds is a writer in the Jam's office at 
Han aid Medical School. 

Academy Takes Flight 


director of the Academy at Harvard Medical School, 
a program that began last February under the lead 
crship of Daniel Lowenstein '83, dean for medical 

Thibault, a professor of medicine at Brigham and 
Women's Hospital, has long been involved in medical 
education. Among his other contributions, he has 
served as a medicine clerkship and residency pro 
gram director at Massachusetts General Hospital, as 
chair of several New Pathway curriculum design 
committees and of the HMS Committee on Years III 
and IV, and as a founding member of the Academy. 

"We want to champion the teaching role of faculty," 
Thibault says. "We want to help faculty become better 
teachers, and we want to innovate, because medicine has changed and we should be 
thinking about different ways to educate our students for this changing world." 

The Academy's success will be measured by increases in the promotion of teaching 
faculty, the quality of the student experience, and the amount of funding raised to 
support education. "Our aim is to bring in new resources that have been specifically 
devoted to paying for teaching time and educational programs," Thibault says. ■ 

Thibault now leads an effort 
to promote and reward 
good teaching at HMS. 


Left Ba n k 

We offer rental of our spacious, 

well appointed 17th century apartment 

home. The period decor includes all 

modern conveniences. The location is 

the finest in Paris, on the Rue de 

Yarenne, 7th Arrondissement. Maid 

sen ice and our Guide to the Best of Paris 

are included for free. 


Caribb e a n 

We offer rental of our wonderful home- 
on the ideal tropical island. Our 
spacious property has a private pool 
and is carefull) tended, perfect for 
honeymoons and relaxing vacations. 
Maid service and our Guide to the Best 
of St Barts are included free ol charge. 

(650) 327-2415 




The Harvard Medical 

Alumni Bulletin 

invites you to place 

an ad in these pages 

Call today to place 
your ad 






A Question of Intent 

A Great American Battle with a Deadly Industry 
by David Kesslcr 77 (Public Affairs, 2001) 


have an audience (and, sadly, too few of us realize 
this). The best kind of memoir is by a hero in a 
war where sides are easy to take. A Question of 
Intent, by David Kessler 77, former commissioner of the Food 
and Drug Administration, is more than 450 pages long — 
always a sign of authorial self-confidence — and the writer 
seems to view himself as a hero on a quest. And so he should, 
for this is not a nostalgic tale of smalltown youth. It's the 
story of the fight to kill the tobacco industry. 

Kessler went to the FDA in 1990 from HMS (which, hum- 
blingly receives only one mention in his book) and law school. 
He was 39 years old and suddenly responsible for an 8,000- 
person agency with a $600 million budget. There were 
prominent fires to douse — product tarn 
pering and the fight for nutritional label- 
ing alone could have absorbed a career. 

Then, in 1991, a staffer suggested that 
the FDA "take on tobacco." It seemed 
ridiculous. But over the next year, the idea 
of taking on tobacco was reshaped: instead 
of regulating cigarettes, the FDA would 
propose to regulate nicotine as an unsafe 
drug under the 1938 Food, Drug, and Cos- 
metic Act. This had never been done before. 
It meant proving that the tobacco industry 
was intentionally manipulating the content 
of cigarettes in order to create addiction. It 
also meant — not to put too purple a point 
on it — shaking a finger at evil. 

The book takes off. The FDA meets its 
first whistleblower, a former R. J. Reynolds employee named 
"Deep Cough." He is the first of many — Veritas, Critical, 
Saint, Research, Cigarette, Jr. — whose names are winsome 
but whose stories are shocking. No surprise that one tobac- 
co lawyer admits that this will be his last job — the position 
pays handsomely because it taints him permanently. 

Kessler pulls together a "Mission Impossible" team to pre- 
pare for his first congressional hearing. Within a month, they 
must learn all there is to know and fear about tobacco, nico- 
tine, and addiction. They need to understand everything that 
has been kept secret for decades. Their sprawling infiltration 
ol the industry — from secret meetings in seedy diners, to 
South American junkets, to glimpses into the roped -off 
rooms of cigarette factories — is a thrilling read. 

Kessler the lawyer convinces Kessler the physician to attack 
the industry on its own attractive philosophical premise. For 

years, ads have intimated the pleasures of choosing to smoke. 
But smokers can no longer choose whether to smoke. In front 
of network cameras, Kessler presents harrowing statistics to 
Congress, the kind a nonscientific mind can grasp clearly 
enough to recoil from. The smoker has no free will 17 million 
smokers try to quit annually, but more than 90 percent fail; 
after lung surgery 50 percent of survivors begin to smoke 
again; 90 percent of addicted smokers begin in adolescence. 
Smoking, the commissioner argues, is, in fact, "a pediatric 
disease" with consequences throughout adulthood. 

It's a clever — and correct — strategy. In 1996, President Clin- 
ton announces a rule allowing the FDA to restrict tobacco on 
both its supply side (no vending machines for children) and its 
demand side (no color advertising appeal or corporate sports 
sponsorships). A coup! Predictions that childhood use of tobac- 
co will be cut by half! Photo ops! Nightly news coverage! 
Then the dark smoking horses rally with a series of legal 
challenges that bring them before the Supreme 
Court. In 1999, the conservative court rules 
five to four against the FDA. It is done qui- 
etly, decisively, and devastatingly The FDA's 
authority is suspended before it can begin. 

That is the simple end of the story. Our 
hero does not triumph. In fact, he leaves gov- 
ernment. But he still re\iews documents in 
his garage late at night (when he isn't acting 
as dean of Yale University School of Medicine 
by day), and this has led him to some striking 
conclusions. Nicotine, he argues, must remain 
available because so many Americans are 
addicted to it. But the nicotine industry must 
be "dismantled" — tobacco companies have to 
be bought out by government, and then over 
seen without profit. These are counterintuitive 
and enormous thoughts. They must be well-attended. 
At times, you wish for a moment of human doubt in a book 
full of the self-confidence of a genuine hero. On the other hand, 
we should all feel as proud of our day jobs. When Kessler the 
Doctor, Lawyer, Commissioner, and Med School Dean 
becomes Kessler the Writer, he occasionally labors under the 
shadow of Raymond Chandler ("it was his prhilege to take 
the tobacco money; it was my prhilege to think poorly of it"). 
But forgive it. He is enjoying himself, and, after all he has 
accomplished, he should. You can almost see him at his desk 
late at night, a neon sign flashing outside the hotel window 
behind him, typing with two fingers on the manual. His felt 
hat is pushed back on his crown, his tie knot hanging below 
the collar, his chin covered with midnight shadow. He has a 
story to tell about an attempt to right history. He will be writ 
ing it into the dawn. Only the dangling cigarette is missing. ■ 

Elissa Ely '88 is a lecturer on psychiatry at HMS. 





Seeds for 



W BetS* 

r la ^1 

Surgery of the Soul 

Reflections on a Curious Career, 
by Joseph E. Murray '43B 
(Science History Publications, 2001) 

In this autobiography, Murray describes 
his role in breakthrough research in 
human organ transplantation and his 
pioneering advances in surgical tech 
tuques to correct deformities of the head 
and face. A Nobel Prize winner, Murray 
is one of the twentieth century's most 
honored surgeons. His autobiography 
tells not only his own story, but also the 
stories of many of his patients. While 
revealing the curiosity, tenacity, opti 
mism, and humanity of a remarkable 
surgeon and scientist, this book demon 
strates the transforming effect of Mur 
ray's care and skill in restoring not just 
bodies, but souls as well. 


Mustang Ranch and Its Women, 
by Alexa Albert '98 
(Random House, 2001) 

As a medical student, -Albert gained 

access to Mustang Ranch, a legal broth- 
er ' o 

el in Nevada, to carry out a study on 
condom use. She found herself unex- 
pectedly drawn into the lives of the 
women she befriended there. The 
brothel workers shared their stories 
with her: how they came to be at Mus- 
tang Ranch, how they had developed a 
deep sense of craft and vocation, how 
they struggled to reconcile their profes- 
sion with the rest of their lives. Albert's 
account of the brothel and its women 

dispels myths and provides an intimate 
glimpse into a largely hidden world. 

Runners' Blood 

by James J. Fischer '61 

(Word Association Publishers, 2000) 

An avid runner himself, Fischer has 
written a medical mystery about cheat 
ing in sports. When the protagonist, 
distance runner Sean Rourke, is beaten 
in a road race by a middle aged man, a 
series ol events are set in motion that 
involve the theft of a scientific discov 
cry, international intrigue, and murder. 

Seeds for All Seasons 

by Alan B. Gazzaniga '61 
(Vantage Press, 2001) 

The author's first novel is a thriller 
about a Harvard neurosurgery student 
in the 1960s, a time when it was not 
uncommon for doctors in- training to 
turn to sperm donation as a way to sup- 
plement their meager paychecks. The 
novel explores the tragic consequences 
of an unregulated practice. 

Harry's Homilies 

Prescriptions for a Better Life, 

by Harry L.S. Knopf '67 (IstBooks, 2001) 

This slim volume is a collection of the 
sayings, wisecracks, and personal philoso- 
phies that appeared in Knopf's monthly 
column in St. Louis Metropolitan Medicine, 
the journal of the St. Louis Metropolitan 

Medical Society. The homilies address 
problems that may be most appreciated 
by physicians, but the underlying mes- 
sages are applicable to people in all pro- 
fessions and lite situations. 

Spectacular Happiness 

by Peter D. Kramer 76 (Scribner, 2001) 

The first novel by the author of Listening 
to Prozac tells the story of Chip Samuels, 
a community college teacher who lives 
by the radical ideals introduced to him 
by his wife, Anais, in the 1960s. But 
Anais has run off with their son in 
search of a more conventional life. Writ 
ten in the form of a letter from Chip to 
his estranged son, the novel opens as 
Chip is named as the chief suspect in a 
series of anarchist bombings of luxury 
beachfront homes. 

Cerebral MR Perfusion Imaging 

Principles and Current Applications, 
by A. Gregory Sorensen '89 
and Peter Reimer (Thicme, 2000) 

This book discusses the basic princi- 
ples of perfusion MR imaging as well as 
present clinical applications in the 
assessment of cerebrovascular diseases 
and intracranial tumors. The authors 
address relevant technical aspects, 
describe contrast agents, provide imag- 
ing protocols, and describe the post- 
processing of images. Included is a CD- 
ROM containing all of the images from 
the book and additional movie clips for 
further analysis. 





Common Aspirin Reveals a Mechanism of Insulin Resistance 


doses of aspirin can reverse 
two major symptoms of type 
2 diabetes by an unlikely 
mechanism. Researchers at the Joslin 
Diabetes Center have harnessed aspirin's 
dramatic ability to lower blood sugar and 
insulin levels to reveal a new protein cul- 
prit that can cause insulin resistance. 
Even better, quashing the molecule 
increased sensitivity to insulin in cells 
and in obese animal models. 

The findings, published in the August 
31 issue of Science, suggest a new molecu- 
lar target to treat insulin resistance and 
type 2 diabetes. The disease affects more 
than 15 million Americans and many 
more people worldwide. It is believed to 
begin with insulin resistance, which is 

made worse by obesity, a sedentary 
lifestyle, and poor diet. 

"This new, provocative hypothesis will 
consume diabetes researchers' interest for 
some time to come and might well lead to 
important and novel therapeutic approach- 
es to the treatment of type 2 diabetes melli- 
tus," writes Morris Birnbaum, a Howard 
Hughes Medical Investigator at the Uni- 
versity of Pennsylvania School of Medi- 
cine, in a perspective in the September 1 
issue of the journal of Clinical Investigation. 

In people, the effect appears to be just 
as potent, reducing circulating levels 
of glucose, cholesterol, lipids, insulin, 
and accompanying clinical symptoms, 
according to preliminary results from a 
follow-up clinical trial of nine obese 
patients presented by Joslin researchers 

RESISTANCE MOVEMENT: Steven Shoelson, Lone Hansen, Minsheng Yuan (from left), 
and others have found a potential new target for the treatment of diabetes. 

at the American Diabetes Association 
meeting in June. 

"It is the most commonly used drug in 
the history of mankind, and here it is with 
another intriguing effect," says Steven 
Shoelson, HMS associate professor of 
medicine at Joslin and senior author of 
the Science paper. Shoelson envisions the 
development of a new selective drug that 
can target the key protein without 
aspirin's potentially fatal side effects. 

The painkiller is best known for its 
effects on the two cyclooxygenase enzymes 
(COXT and COX- 2), but other researchers 
recently have shown that aspirin and its 
chemical cousin sodium salicylate also 
weakly but specifically inhibit the protein 
I kappa- B kinase -beta (IKK-beta). The 
kinase is named for its role in the cascade 
of signals that activate the nuclear factor 
kappa B (NF-kappa-B) family of genes, 
which regulate inflammatory and immune 
responses. Now it turns out that IKK-beta 
also works in another pathway to con- 
tribute to insulin resistance by interfering 
with insulin signaling. 

The distinction is in the dose. At 80 
milligrams, a baby aspirin tickles COXT 
in blood platelets, discouraging them 
from sticking to vessel walls. At 650 mil- 
ligrams, aspirin inhibits COXT and 
COX-2 in most tissues, calming inflam- 
mation, lowering fever, and reducing 
pain. At a whopping 5 to 8 grams a da) — 
doses used to control rheumatic fever and 
rheumatoid arthritis — there is enough 
aspirin to inhibit IKK-beta. The problem 
is that aspirin, at these high doses, can 
cause dizziness, tinnitus, impaired hear 
ing, nausea, vomiting, sweating, drowsi- 
ness, diarrhea, and headache. Other 
potentially life threatening side effects 

include gastritis and gastric ulcers lead- 
CD o 

ing to gastrointestinal blood loss, as well 
as liver and kidney complications. 

Jamming the Signals 

Shoclson's group had been working on 
molecular mechanisms for insulin resis- 





tancc. They were particularly 
interested in the cross talk 
between the signaling pathways 
for insulin, beginning with the 
insulin receptors, and for TNF 
alpha, a cytokine released by 
bloated fat cells, which appeared 
to promote insulin resistance. A 
1998 paper in Nature caught their 
attention with the news that high 
doses of salicylates specifically 
target the IKK beta protein kinase 
in the TNF- alpha pathway. 

"So we asked if high doses of 
salicylates had an impact on 
insulin resistance in animals," 
Shoelson says. "It was striking. 
High doses had a huge impact." 

High doses of aspirin amelio 
rated the severe insulin rcsis 
tance seen in the genetically 
obese rodents, Zucker fa/fa rats 
and ob/ob mice. A closer look at 
the liver and muscle tissue from 
treated animals and subsequent 
studies of cultured fat and liver 
cells exposed to TNF alpha 
suggested that the fat released 
cytokine activates IKK beta, which 
in turn gums up the insulin sig- 
naling pathway by diverting phosphory 
lation of the insulin receptor substrate 
necessary to carry the insulin signal deep 
into the cell. High doses of aspirin pre 
vented that unhealthy molecular cross- 
talk between the pathways by inhibiting 
IKK beta. 

Potential New Use for Old Drug 

Further studies in genetically modified 
mice clinched the investigation. Homo 
zygous Ikk beta knockout mice don't 
live, so the researchers looked at het- 
erozygous Ihh beta* mice having a 50 
percent reduction in IKK beta. They 
found reduced fasting glucose and fast 
ing insulin levels compared to litter 
mates with both Ikfc-beta genes. The 
researchers unmasked a larger effect by 
feeding the mice a high fat diet and 
crossing both the partial knockout and 


IKK Complex 





Better known for its role in the NF-kappa-B 
pathway, a kinase in the IKK complex can 
also gum up the signaling pathway for 
insulin. Cross-talk between the two path- 
ways can cause insulin resistance, accord- 
ing to a Science paper by Joslin Diabetes 
Center researchers. It turns out that a 
kinase in the IKK complex, IKK-beta, some- 
how discourages the tyrosine phosphoryla- 
tion of insulin receptor substrates. This 
process interferes with the insulin signaling 
pathway necessary for the cell to store and 
use glucose and other nutrients from the 
blood. IKK-beta may be activated by TNF- 
alpha from fat cells or by other stimuli asso- 
ciated with insulin resistance and diabetes. 

normal mice with ob/ob mice. Even the 
50 percent reduction in the Ifck beta gene 
reduced fasting glucose and insulin con- 
centrations and protected against insulin 
resistance. The results may explain why 
such weak inhibitors of IKK-beta as 
aspirin and fellow salicylates have signif 
icant effects on glucose and lipid home 
ostasis, Shoelson says. 

In a related study published in the 
August 1 issue of the Journal of Clinical 
Investigation, the Yale research laboratory 
of Gerald Shulman, in collaboration with 
Shoelson's group, found that high dose 
salicylate and reduction of IKK beta in 
heterozygous M-beta+A mice prevented 
insulin resistance in muscle tissue caused 
by an infusion of free fatty acids. Free 
fatty acids are known promoters of 
insulin resistance and are believed to 
activate PKC-theta, which in turn acti 
vates IKK beta. 

In hindsight, Shoelson says, 
"We now recognize a striking 
overlap between stimuli that acti- 
vate IKK-beta and conditions 
that promote insulin resistance, 
including proinflammatory cyto- 
kines such as TNF-alpha, hyper- 
glycemia, phorbol esters, PKC 
enzymes, serine/threonine phos- 
phatase inhibitors, and bacterial 
lipopolysaccharide. These activa 
tors of IKK beta cause insulin 
resistance in vivo or as experi- 
mental models in cultured cells." 
Aspirin's pronounced impact 
on the symptoms of diabetes is not 
exacdy new to medicine, Shoelson 
discovered when he searched the 
literature. In 1876, a German pro- 
fessor described the fast improve- 
ment and transient disappearance 
of symptoms in two men, ages 58 
and 59, who were suffering from 
what doctors now recognize as 
classic type 2 diabetes. In the late 
1950s, scattered reports resurfaced 
with equally dramatic results. 
Physicians and researchers likely 
were discouraged by the severe 
side effects of aspirin, stumped by 
the mechanism of action, and encouraged 
by new drugs on the market, including 
insulin in the 1920s and the sulfonylurea 
class of oral antihyperglycemic drugs in 
the 1950s. Insulin resistance, upon which 
aspirin exerts its most beneficial effects, 
was not yet recognized. 

"The potential of salicylates for treat 
ing diabetes had been all but forgotten 
by modern biomedical science," Shoel 
son says. "It's been a lot of fun rediscov- 
ering this effect and identifying the mol 
ecular target, but the hard work is yet to 
come. What we really need is a better, 
more specific "aspirin' that reverses 
insulin resistance without all of the side 
effects. We don't know whether this is 
possible, but it certainly is what we'd 
like to accomplish." ■ 

Carol Cruzan Morton is a science writer 
for Focus. 



Class Day student speakers recall hurdles 
overcome and explore challenges ahead 




Class of 2001 to take on broad responsibility as 
"healers of society," Class Day keynote speaker 
Benjamin Carson urged graduates to bear in 
mind how sound character can spring from 
overcoming adversity. Recalling how his moth- 
er, a hardworking single parent, enabled him to 
escape the violence and poverty of the Boston 
tenements where he grew up, Carson noted 
that hardship is not necessarily "such a bad 
thing, because it puts fire in your belly." 

Carson also stressed the importance of 
respecting the roles of faith and spirituality in 
the work done by physicians, stating, "I think 
we should make it clear as we go forth, with 
all of our tremendous knowledge, that it's 
also okay to go forth with Godlike principles 
of caring about your fellow man, of loving 
your neighbor, of developing your God-given 
talents to the utmost so you become valuable 
to the people around you." 

While Carson put the focus on general prin- 
ciples to follow in the pursuit of success, which 

he defined as using and multiplying one's skills 
"to elevate other people," both medical student 
speakers at the Class Day ceremony described 
the ardors they and their classmates faced on 
the path to becoming physicians. 

Jeffrey Munson, the first medical student 
speaker, pointed out that the occasion was not 
only a day of celebration; it was also a day when 
students take on a responsibility to society. He 
told his classmates and their families that med 
icine is more than just a career. 

"When we become physicians," he said, 
"we make a promise: a promise of humble 
service, a promise to temper natural greed 
with a selfless concern for our patients, a 
promise to fight for those who cannot or will 
not fight for themselves, a promise to see all 
comers for what lies within, a promise never 
to abuse the trust that is given to us by those 
with nowhere else to turn." And he urged the 
new physicians to "live in refutation of those 
who would have self-interest replace our 
sense of duty." 





■ ■ - . 



by Michael Higgins 

The other medical student speak 
er, David Joyce, kept the audience 
laughing, even as he described the 
challenges the graduates faced on 
their way to hecoming doctors. 
"Thomas Jefferson incurred less debt 
when he purchased the Louisiana 
Territory from the French back in 
1803," he noted. 

At the end of his talk, in a serious 
moment, Joyce reminded his class- 
mates to "never doubt that the grat- 
ification of serving other people is 
far more valuable than any material 
gain or personal achievement." 

This year HMS awarded 157 MDs 
to 75 women and 82 men. Twenty- 
nine percent of the graduates are 
underrepresented minorities, and 
18 percent are candidates for an 
additional degree. Thirty-seven 
degrees were awarded through the 
Harvard-MIT Division of Health 
Sciences and Technology. Twenty 
MD-PhD degrees were awarded to 
four women and 16 men, and 68 
PhDs were granted to 27 women 
and 41 men. ■ 

Michael Higgins is the editorial assistant 
for Focus. 


The following medical degree recipients graduated 
with honors or special awards: 

Murat Zeki Akalin 

and Rey Francisco Ramos 

Robert H. Ebert Primary Care 
Achievement Award for excellence 
and outstanding accomplishments in 
the field of primary care medicine 

Samuel Morris Brown 

Rose Seegal Prize for the best paper 
on the relation of the medical profes- 
sion to the community: Use of 
WHONET Software and Electronic 
Communication for Monitoring Antimi- 
crobial Resistance: Preliminary Results 
from Russia 

Esiquio Gustavo Casillas 

The Community Service Award to the 
senior who has done the most to exem- 

plify and/or promote the spirit and 
practice of community service 

Anne Meredith Chapas, 

cum laude 

Functional Analysis of the Fucosyltrans- 

ferase VII Promoter in Leukocytes 

Clark Chin-Chung Chen, cum laude 
Saccharomyces cerevisiae SGS 1 
Suppresses Homeologous Recombina- 
tion, Non-homologous Recombination, 
and Telomeric Addition 

Howard Frederick Fine, 

cum laude 

The Role of Vascular Endothelial 
Growth Factor in Uveitis- Associated 
Cystoid Macular Edema 


For over two thousand years, doctors have taken an 
oath to affirm a commitment to their profession. This 
oath has served as a contract with their community and 
as a tribute to their teachers. In this vein, the Class of 
2001 has created an oath that draws upon elements 
from the oaths of their teachers, both recent and 
ancient. I now invite you, as a class, to share in this 
tradition and to articulate the ideals and principles 
that will guide you in the years ahead. 

I solemnly swear, by all that I hold most sacred, that: 

1 will make the well-being of my patients my utmost concern. 

I will sec in each patient a fellow human in pain, and always be diligent and tender as 

seek to relieve suffering; 
1 will keep sacred the bond between doctor and patient and will respect the confidences 

entrusted in me; 
I will honor my patients' autonomy and dignity both in living and in dying; 
I will maintain the utmost respect for human life and will not use my medical knowledge 

contrary to the laws of humanity; 
I will work, in whatever house I enter, for the benefit of the sick, and will not commit any 

voluntary act of mischief or corruption; 
I will promote the well being of the community; 
I will honor my mentors and continue to seek new knowledge, to teach, and to advance 

the art and science of medicine; 
I will work in diligent and honest collaboration with my fellow practitioners; 
I will maintain the honor and noble traditions of the medical profession; 
I will be truthful, honest, modest, merciful, and objective; 
I will admit my mistakes, amend my ways, and forgive the wrongs of others; 
Today in the presence of family, friends, teachers, and colleagues, I dedicate myself to the 

profession of medicine dental medicine. 
Here am I, ready for my vocation, and now I turn unto my calling. 




Elizabeth Bowen Fortescue, cum laude 
Risk Stratification in Coronary Revascular- 
ization: Current Concepts and Future 

Jason Louis Gaglia, 

magna cum laude 

Leon Reznick Memorial Prize for excel- 
lence and accomplishment in research: 
Mediators of B7/CD28-lndependent 
Costimulation of T Cells 

David Avram Ganz, cum laude 
Cost-Effectiveness of HMG CO-A 
Reductase Inhibitors in Older Patients with 
Myocardial Infarction 

Andrew James Gerber 

Dr. Sirgay Sanger Award for excellence 
and accomplishment in research, clinical 
investigation, or scholarship in psychia- 
try: Literature Review of Psychoanalytic 
Outcome Research 

Neil Samuel Ghiso, cum laude 
The NBI Healthcare Foundation Human- 
ism in Medicine Award to a graduating 
medical student who consistently demon- 
strates compassion and empathy in 
the delivery of care to patients; The Oxy- 
gen Regulation of Vascular Endothelial 
Growth Factor and Its Suppression by 
Nitric Oxide 

David Charles Gordon 

The Society for Academic Emergency 
Medicine Excellence in Emergency Medi- 
cine Award to a senior medical student 
who has demonstrated excellence in the 
specialty of emergency medicine, and 
the Gerald S. Foster Award in recogni- 
tion of contributions to the student body 
by virtue of serving on a student-faculty 
committee including but not limited to 
the Committee on Admission 

Beverly Ashland Guadagnolo 

Bemy Jelin '91 Prize to that senior who 
most demonstrates overall academic 
excellence with a career interest in pedi- 
atrics, oncology, international health, 
or psychiatry 

Roy Hoshi Hamilton, cum laude 
Kurt Isselbacher Prize to the senior 
demonstrating humanitarian values 
and dedication to science; Metamodal 
Cortical Processing Demonstrated in 
the Occipital Cortex of Blind and 
Sighted Subjects 

David Shumway Jones, 

magna cum laude 
Richard C. Cabot Prize for the best 
paper on medical education or medical 
history: Visions of a Cure: Visualization, 
Clinical Trials, and Controversies in Car- 
diac Therapeutics, 1 968- 1 998 

Emily R. Katz, Walter John Lech, 

Constance Alexis Marks, 

Raul Ruiz, and Xun Clare Zhou 

The Multiculturalism Award to the senior 
in each Academic Society who has done 
the most to exemplify and/or promote 
the spirit and practice of multiculturalism 
and diversity 

Colette Monique Knight, cum laude 
Mechanisms of Regulation of 
Gonadotropin Subunit Gene Expression 
by GnRH 

Anne Shee C. C. Lee, cum laude 
Complementary and Alternative 
Medicine: Providers, Practices, and 
Pediatric Care 

Diego Esteban Marra, 

magna cum laude 

James Tolbert Shipley Prize for excellence 
and accomplishment in research: The 
Molecular Mechanism of Vascular 
Smooth Muscle Cell Growth Inhibition 
by Sodium Salicylate 

Erica Elizabeth Marsh, 

cum laude 

Wyeth-Ayerst Scholar in recognition 
of extraordinary accomplishment and 
potential to make significant contribu- 
tions in the field of women's health: 
Absence of Nocturnal Acrophase of 
Leptin in Controlled Circadian Studies 
in Normal Women 

Bridget Kathleen McCabe, 

cum laude 

Reduced Neurogenesis Following 

Recurrent Neonatal Seizures 

Andy Olivier Miller, cum laude 
Optimizing Secretion of Large Heterolo- 
gous Antigens in Attenuated Vibrio 
Cholerae Vaccine Strains with the 
Escherichia Coli Hemolysin Export System 

Eric Matthew Morrow, 

magna cum laude 

Harold Lamport Biomedical Research 
Prize for the best paper reporting original 
research in the biomedical sciences: 
Abnormal Photoreceptor Morphogenesis 
in Crx-null Mice: A Model for Leber's 
Congenital Amaurosis 

Deanna Diemanh Nguyen, 

magna cum laude 
Henry Asbury Christian Award for 
notable scholarship in studies or research: 
Wiskott-Aldrich Syndrome Protein (WASP)- 
Deficient Mice: A Novel Th2 Model of 
Inflammatory Bowel Disease 

Marco Valentin Perez, cum laude 
A Tripartite mdm2/p53/p300 Complex 
That May Regulate p53 Degradation 

Rebecca Bernstein Perkins, cum laude 
Spectrum of Neuroendocrine Abnormali- 
ties, Response to Neurotransmitter Modu- 
lation, and Predictors of Recovery in 
Hypothalamic Amenorrhea 

Jean Leclerc Raphael 

The New England Pediatric Society Prize 
to the senior who, in the opinion of peers 
and faculty, best exemplifies those quali- 
ties one looks for in a pediatrician 

Amir H. Taghinia, cum laude 
Regulation of Axon Growth and Gene 
Expression Is Mediated Through a Purine- 
Sensitive Pathway 

Barbara Saatkamp Taylor, cum laude 
Gene Expression and Transcriptional 
Profiling of Adipogenesis: In Vivo and 
In Vitro Models 

Ping Zhou, cum laude 
Cloning and Characterization of the 
Promoter Region of Mouse Telomerase 
Catalytic Subunit (mTERT) Gene and 
Comparing the Promoter Activity with 
Its Human Counterpart 



A physician describes the power c 



that has ever really interested me. I can remember as a 
youngster spending many hours in the hallways ol 
Detroit's Receiving Hospital or Boston City Hospital 
because we were on medical assistance and had to wait 
until one of the interns or residents was free to see us. 

I didn't mind at all, because I was in a hospital, and I 
would occupy myself by listening to the P.A. system. "Dr. 
Jones, Dr. Jones to the emergency room. Dr. Johnson, Dr. 
Johnson to the clinic." And I would just imagine that one 
day they'd be saying, "Dr. Carson, Dr. Carson to the O.R." 
Of course, now we have beepers, so I still don't get to hear 
it. But it was so important to have that dream. 

Life kind of fell apart for me quite early on. My parents 
got divorced. My mother, who was one of 24 children, got 
married at age 13. She and my father moved from rural Ten- 
nessee to Detroit, where he worked in a factory. She dis- 
covered that he was a bigamist and had another family We 
ended up moving to Boston to live with my aunt and uncle 
in a typical tenement — rats, roaches, sirens, gangs, mur- 
ders. Our heroes were the drug dealers because they gave 
candy to the kids. I can remember seeing people lying in 
the street with bullet holes in their chests. 

It really does make an impression on you when you 
become extraordinarily familiar with the burden of pover- 
ty. But I'm not so sure that it's such a bad thing, because it 
puts fire in your belly. Hardship is good, and that's some- 
thing that I want you all to remember over the next few 
years as you go through internship and residency. It's a 
good thing. It too will pass, and life should get better at 
some point. 

My mother believed that if she worked hard enough — 
she worked as a domestic, cleaning other people's houses, 
two or three jobs at a time — one day she could become 

>oor, with no money for anything 


believing in oneself by BENJAMIN CARSON 

independent. Eventually we moved back to Detroit, still in 
dire poverty, still in a multilamily dwelling. 

I was a terrible student at that time, probably the worst 
student you've ever seen. My nickname was "Dummy" 
because I didn't know anything. And I remember once we 
were having a disagreement about who the dumbest per- 
son in the class was. It wasn't that big of a discussion, 
because everyone agreed that I was the dumbest. But some- 
one tried to extend the argument to whether I was the 
dumbest person in the world, and 1 took exception to that, 
so we had a really vigorous argument. 

Unfortunately, we had a math quiz that day, and I got a 
zero. Now, that wasn't a problem; I always got a zero. The 
problem was that on this day the teacher said you had to 
pass your test to the person behind you and let that person 
correct it and give it back to you. Then the teacher would 
call your name and you had to report your score out loud — 
not a problem if you got a 100 or 95, but a big problem if 
you got a zero and had just had an argument about the 
identity of the dumbest person in the world. 

I couldn't find a way to get out of the class, so I thought I 
would scheme. I said to myself, "You can figure out a way 
out of this. When the teacher calls your name, just mumble. 
Maybe she'll misinterpret what you said, write it down, and 
move on." So when she called my name, I said, "Nnnumph." 
And she said, "Nine? That's wonderful, Benjamin! I knew 
you could do it il you just applied yourself! Class, I want you 
to understand the significance of this. If Benjamin has got- 
ten nine right, anybody can get nine right. If Benjamin got a 
nine..." and she went on ranting and raving. 

Finally the girl behind me couldn't take it any longer. She 
stood up and said, "He said, 'None.'" The teacher was so 
embarrassed, and the kids were rolling in the aisles. If I could 
have disappeared into thin air, never to be heard from again in 

the history of the world, I gladly would have done so. But I 
couldn't. So I just sat there and acted like it didn't bother me. 

But it did. It bothered me a lot — not enough to make me 
study, but it bothered me a lot. Fortunately, I had a mother 
who believed in me when nobody else did. And she prayed 
to God to give her the wisdom to know what to do to get 
her sons to develop their minds. And God gave her the 
wisdom — at least in her opinion. My brother and I didn't 
think it was all that wise. Turn off the TV set? What kind 
of wisdom was that? As tar as we were concerned, that was 
child abuse. 

But she said we could watch only two or three TV pro- 
grams per week. And with all that spare time, we had to 
read two books apiece from the public library and submit 
to her book reports — which she couldn't read, but we 
didn't know that. She put little check marks on them; I 
thought she was reading them. 

An interesting thing began to happen. We were desper- 
ately poor, with no money for anything. But between the 
covers of those books, I could go anywhere. I could be any- 
one. I could do anything. I was imagining myself in a labora 
tory pouring chemicals into beakers, and wiring electrical 
circuits, and discovering microcosms under the microscope. 
I could never pass up a puddle without getting a specimen 
and peering into the microscope at school at the hydra and 
the paramccium and the volvox and all those things. It was 
fascinating. I could be there for hours. 

Something funny happened. After a while, the teacher 
would ask a question and I would be the only person with 
an answer. And by the time I was in the seventh grade, I'd 
gone from the bottom of the class to the top of the class. 
much to the consternation of all those students who used 
to laugh and call me Dummy. The same ones would now- 
come to me and say, "Benny, how do you work this prob 

But between the covers of those books, I could go anywhere.// 







lem?" And I'd say, "Sit at my feet, youngster, while I instruct 
you." I was perhaps a little obnoxious, but it felt so good. 
But I got to the point where if I got a 99 on a test and some- 
body else got a 100, it was devastating. I couldn't live with 
myself. I'm sure some of you can identify with this. 

I remember when I was in the ninth grade, I went up to 
some of my classmates and asked, "Guys, why do you hate 
me so much?" And they looked me dead in the eye and said, 
"It's because you're so obnoxious." And I said, 
"Obnoxious? Moi?" They said, "You always have to 
have the highest grade in everything," and it was 
like someone had stabbed me with a dagger, 
because I knew it was true. I had become just 
like the people that I hadn't liked before. And I 
realized that all I had to do was my best, that I 
didn't really need to compare myself with anyone 
else. And a tremendous burden was suddenly lifted 
from my shoulders. 

What's really important in that story is recognizing that 
when I was in the fifth grade, I thought I was stupid, so I 
conducted myself like a stupid person and achieved like a 
stupid person. When I was in the seventh grade, I thought 
I was smart, so I conducted myself like a smart person and 
achieved like a smart person. 



Benjamin Carson 

expounded on the 

importance of faith — 

both in oneself 

and in God. 

What does that say about expectations? We 
as health care providers are among the most 
highly educated people in society. We have to 
take a stand, because there is so much igno 
ranee in our land right now. When we compare our students 
in grade school and high school with students in other indus- 
trialized nations, we see that we're scraping the bottom of the 
barrel. We cannot afford to continue to do that as we move 
further into the technological age. 

So when you take on that mantle as a doctor, think 
about being a healer. Think about being a person who pro- 
motes the kinds of values that encourage young people to 
develop themselves successfully. Because if we don't 
do it, who else will? And our efforts will make a 
big difference. 

Think back on other great societies — ancient 

Egypt, ancient Greece, ancient Rome — top of 

the world, no competition, just like we are right 

now. Where are they now? What happened? 

They became enamored of sports and entertain 

ment, lifestyles of the rich and famous; they lost 

their moral compass and they went right down the tubes. 

Some people say it can't happen in this nation, but I believe 

it's already happening. And the question is, can we stop it? 

When we go out there, we have to do more than just be 

excellent in our laboratories and operating rooms and clinics. 

We have to espouse the right kinds of things, be healers of 

society. What a difference we can make if we do that. 



And think about the intellectual aspect of human beings. 
Is there anything as wonderful as the human brain? I say that 
not only as a neurosurgeon, but also as a human being. It is a 
wonderful organ system, more complex than any computer. 
It invented the computer. It can process more than two million 
bits of information per second, and it remembers everything 
you've ever seen, everything you've ever heard. 

The human brain can do all of that, and we barely have to 
think about it. Can you imagine what the human brain is 
capable of when we actually put some energy into a project? 
That's what we've got to start considering. 

You would have thought that, having understood those 
kinds of things, I was on my way. But then I got to high school 
and got caught up in peer pressure. My grades began to drop. 
Fortunately, I eventually got back on the right track and won 
a scholarship and went off to Vale. But that peer pressure is 
something that continues throughout life. And it is an awful 
thing in medicine. 

For instance, that intern, that resident — they're nice people. 
You like them, they have a sense ol humor, they're wonderful. 
But by the time they're chief resident, they're some of the nasti 
est SOBs you've ever seen What happens along the way? Peer 
pressure. When people begin to think that it's macho to yell at 
people and to throw instruments around the operating room, 
we in the medical profession have to stamp that kind of thing 
out. That's not who we are. That's not who we should become. 

You're also going to hear people saying, "Don't become 
emotionally attached to your patients because you're going to 

be hurt." I have never discovered how not to be emotionally 
attached to my patients. When a young child comes in with 
a brain tumor and I see his distraught mother and I think 
about my own children, 1 can't become detached. When I 
look at the brain that makes that person who they are, I can't 
become detached. 

You're going to be very busy. But remember that it means so 
much to your patients when you show some caring. Instead of 
standing at the door for five minutes proclaiming how busy 
you are and how you haven't slept for two days and how you 
can't do anything, if you were to go in that room, sit down on 
the bed, and put your hand on your patient's hand and say, 
"Mrs. Jones, I understand you're having some problems and I 
will be back as soon as I can," and walk out the door, it would 
mean so much more than that five minute dissertation, just 
showing some compassion. 

Patients really do respond. I've never spent a day in court, 
even though my specialty is neurosurgery, and it's not 
because I haven't made any mistakes. But if you are honest 
with people and if you care, they will see that and they won't 
sue you. I can guarantee you that. Spend time with them 




because, as I tell my residents, you can spend 
time with them now or you can spend time 
with them in court. You make the choice. 

The other important thing about peer 
pressure is this: don't be like the people of 
my generation who sit there and complain 
about how managed care is destroying med- 
icine but don't do anything about it, leaving 
decision making in the hands of business- 
people who arc also responsible for earnings 
per share. They're never going to make the 
right decisions. We can't allow that to con 
tinue. We're the only people who can advo- 
cate for patient rights. No one else under- 
stands the way we do. 

Unless we come up with alternative proposals and stop 
complaining, nothing is going to get done. People are say- 
ing the pendulum is going to swing back. It isn't going to 
swing back, because people don't give up an advantage 
when they have it. We've got to force the pendulum back, 
and that's part of what we do as healers of society. We are 
the people responsible for health. And I don't care how 
many business degrees you have; you can't be responsible 
for people's health. That MD, that DDS, is going to put you 
in a special and trusted position. This is our last 
chance, your generation. We cannot squander it or 
we are going to squander our profession. 

Finally, what is success in life? Is it big hous- 
es and fancy cars and all that stuff? I don't think 
so. I have those things, but I don't think they 
define success. 

In 1997, when I was asked to go to South Africa 
to lead a team to separate type II conjoined twins, 

I knew I was facing a great medical challenge. The twins 
were joined at the top of the head, facing in opposite direc- 
tions. There had been 13 previous attempts to separate type 

II conjoined twins, but none had been successful. 

But there was another aspect. It was going to be done at 
the Medical University of Southern Africa, the only major 
black teaching hospital in that country. They thought if 
this operation could be done there, they could stand shoul- 
der to shoulder with Cape Town, Johannesburg, and all the 
great universities. 

I wasn't ready for that social pressure, so I said, "Lord, 
you've got to help me, because smarter and more capable 
people than me have tried and failed." As I was studying the 
various radiographs, I noticed that the drainage system that 
the twins shared was a little narrower in the middle than it 
was on either end. I felt strongly that I should not do what 
the traditional literature says, which is to decide which one 
to give the drainage system to and divide the other one over 
the course of several operations, to allow collateral circula- 
tion to develop. Instead, I felt we could divide it right in the 
middle and that the circulation would adjust itself intraop- 
eratively and that the twins would, in fact, be able to survive. 

When I explained that to the group, they said, "You're 
the boss. We're going to do what you want us to do." I 




Graduates took 

inspiration from 

Benjamin Carson's 

message of 

discipline and 


remember going into the operating room two days before 
the New Year of 1998. There was a big sign in the operat- 
ing room that said, "God bless Joseph and Luka Banda." 
They were having song service and prayer service. I was 
thrilled. I asked them to bring in a stereo system so we 
could play inspirational music. 

Nineteen hours into the surgery, we were only three- 
quarters of the way finished. The part that remained 
looked impossible: the blood vessels were engorged, 
adhesed, and entangled. We stopped the operation 
and went into conference. 

I said, "Maybe we can just cover that area 
over with skin and come back in several 
months, and maybe they'll have developed col- 

lateral circulation and we can cut through that 

area and they'll survive." And the doctors from 

Zambia, where the twins were from, said, 

"That's a great idea. We know you can do that at 

Johns Hopkins, but we don't have the ability to keep 

partially separated twins alive." 

Now I really felt the weight of the world on my shoul 
ders as I went back in there without all my fancy equip- 
ment. I had my scalpel and a prayer on my lips. I said, 
"Lord, it's up to you." I started to cut between those vessels 
that were thinner than a sheet of paper — you could sec the 
blood coursing through them. I felt so helpless. But just 
when I made the final cut between those two twins, over 
the stereo system came the "Hallelujah" chorus. Everyone 
had goose bumps. 

One of those twins, when we finished that operation 
after 28 hours, opened his eyes and reached up to the tube. 
By the time we got to the ICU, the other one did the same 
thing. Within two days, they were extubated. Within 
three days, they were eating. Within two weeks, they were 
crawling around perfectly normal and they remain that 
way today. 

But that wasn't the success. The success you had to be 
there to witness. People were following this story closely 
in the papers and on the radio and television, and they 
were ecstatic. People were literally dancing in the streets. 
We could not walk down the hallway. And that's what I 
think is real success, when you take talent that God has 

given you and you multiply it and use it to elevate other 
people. And that's what I mean when I say, THINK RIG. 

The T is for talent, which God gave to every single per 
son: not just the ability to sing and dance and throw a ball 
but influential talent. You have it. Please use yours to 
develop yourself in your sphere of influence. 

The H is for honesty. If you lead a clean and honest life, 
you wont put skeletons in the closet because if you do, 
they always come back and haunt you just when you don't 
want to see them. 

The I is tor insight, which comes from listening to peo- 
ple who've already gone where you're trying to go. No need 
to reinvent the wheel. 

N is for nice; be nice to people, because once they get over 
the suspicion of why you're being nice, they'll be nice to you. 
You get so much more done that way. 

The K is for knowledge, which is the thing that makes 
you a more valuable person. Yes, I live in a big house and 
have a lot of stuff. But you know, if someone took all that 

away today. I wouldn't care. It would mean nothing. 
Why? Because I could get it all right back almost 
immediately with what's in my head. That's what 
Solomon, the wisest man who ever lived, meant 
when he said that gold and silver and rubies are 
nice, but to be treasured far above those are know 1 
edge, wisdom, and understanding, because they are 
what give you a sense of what's really important. 

The B is tor hooks, which are the mechanism of 
obtaining that knowledge. 

o fS 

The second I is for in-depth learning, learning for 
the sake of knowledge and understanding versus 
superficial learning. Superficial learning is for peo- 
ple who cram before a test Sometimes they do well, 
but three weeks later they know nothing. That's 
how we got to be number 21 in a survey of grade 
school students in 22 industrialized nations. We 
can't afford that. 

The last letter, G, is for God. Many people get a lot 
ol degrees behind their names and start trying to 
rearrange the letters to make them spell God. There's 
something special about recognizing that there's a 
higher power. We live in a society now where people 
are trying to exclude God. 

I wonder ll those people know that this country 
was founded on religious principles. 1 wonder if 
they understand that the preamble to our Constitu 
tion. that our Bill of Rights, talks about certain 
inalienable rights that were given by our Creator — 
God. I wonder if they notice the Pledge of Allegiance 
to our 1 lag, w hich says that we are one nation under 
God. I wonder if they've ever been in a courtroom 
where on the wall it says, "In God we trust." Do they 
have any money? Every coin in our pocket, every bill 
in our wallet says, "In God we trust." 

So when people talk about the separation of 
church and state, what do they mean? If God is on 
all those things and we can't talk about His presence 
I think it's a form of schizophrenia. And doesn't this 
explain a lot of what has been going on in our nation today? 
I think we should make it clear as we go forth, with all ot 
our tremendous knowledge, that it's also okay to go forth 
with Godlike principles of caring about your fellow man, 
ol loving your neighbor, of developing your God -given tal 
ents to the utmost so you become valuable to the people 
around you, of having values and principles. 

And when you do that, not only will you be healers 
when you go into the hospitals and clinics, but you'll also 
be healers of society and you'll start us on the way to tun- 
ing something we've talked about since kindergarten, and 
that is one nation under God, indivisible, with liberty and 
justice for all. ■ 

Benjamin Carson, MD, has been director of the Division of Pediatric 
Neurosurgery at]ohns Hopkins since 1984. He is also co director of the 
Johns Hopkins Craniofacial Center Carson is the author of three best 
selling books. Gifted Hands, Think Big, and The Big Picture. 





A graduate reflects on the sacred and binding trust the 


the accomplishments of those fortunate enough to be 
sitting here, it is a celebration well-deserved. Our loved 
ones have gathered to join us in commemorating the suc- 
cesses of our recent past, and to indulge, if only a little, 
in our pride. In this setting, it is easy to be distracted by 
our achievement and to see only the festivities at hand. 

But today is so much more than a celebration. It is 
also a day of ceremony, an occasion on which we join a 
covenant with society that has defined our profession 
for centuries. A nation of those who will be our 
patients has gathered just beyond the circle of familiar 
faces, just beyond the edges of the present. They are 
strangers, friends, parents and children, colleagues, 
ourselves. They come with their lives in their hands, 
uncertainty in their eyes, and hope in their hearts. And 
they bring us their trust, so fragile and so precious, and 
their respect, so rarely given in our time. 

They are a nation of the sick, and they stand 
in silence, waiting to witness the promise of a 
new generation of physicians. Although they 
make no sound, their questions are as clear 
as their needs: When there is no one left 
beside me, will you take my hand and walk 
with me? Will you resist the temptation to 
deceive me, when I have neither the strength nor 
the knowledge to know the difference? Will you 
keep your midnight vigil, so that I may sleep without 
fear of the dark? Will you use your considerable talents 
with humility? And will you, on this, your day of private 
celebration, stand tall and make public your profession 
that above all else, you will do no harm? 

These questions are the fundamental challenges of 
the lives we have chosen, and rising to meet them will 

Jeffrey Munson 
reaffirmed the extra- 
ordinary covenant that 
exists between doctors 
and patients, which he 
called both a duty 
and a privilege. 

require great sacrifice, just as the path to this moment 
has demanded so much. But the road that lies ahead, 
past the gateway of our promise to serve those in need, 
is as rich and beautiful as it is arduous. It is a passage 
through a world so real it strains to be called a dream 
for fear that the pain and the pleasure may become too 
much to bear. 

The language that surrounds us is an intimate com- 
munication of yearning and connection, rather than the 
superficial pleasantries that seek to create rather than 
cross distance. As the sick and the well pass one anoth- 
er, the meeting of I and Thou bonds strangers in a 
moment of transcendent human understanding. 

It is a world in which a gentle touch engenders trust, 
not suspicion and fear; a world in which pain and lone- 
liness can be transformed into peace and partnership. It 
is a world in which suffering is profound, but the gift of 
hope and life even in the face of death is more pro- 
found still. And as physicians, we are the trav- 
elers blessed with the opportunity to walk 
among the sick in this world of human reali- 
ty, bringing that gift of hope and life to each 
bedside as we journey on toward our own 
eternity. That is our duty, and that is our 
greatest privilege. 

There are those both outside and within our 
profession who would dismiss the notion of a soci- 
etal covenant as romanticized folly, and who discuss 
medicine as a career in which payment is given for ser- 
vices rendered in a world no different from that of 
everyday life. I could not disagree more. When we 
become physicians, we make a promise: a promise of 
humble service, a promise to temper natural greed with 
a selfless concern for our patients, a promise to fight for 

// They bring us their trust, so fragile and so precious 




society places on doctors by JEFFREY MUNSON 

nowhere else to turn. It is in exchange for 
the fulfillment of these promises that 
society places in our care its most fragile 
and vulnerable citizens. That is the 
nature of our covenant, and it must tran 
scend the realm of ordinary business, for 
it is a transaction in human life. So, too, 
must our profession rise above the level 
ot a trade organization, for we are the 
stewards of this contract, and our collec 
tive tailure would create so much more 
than a monetary cost. 

So as we leave here today, let us have 
the strength and courage to follow our 
calling and live in refutation of those 
who would have self-interest replace our 
sense of duty. Let us live in keeping with 
our oath, and let us fulfill our obligation 
of service. 

When we become weary of the road 
ahead, let us pause to breathe in the 
richness of our world, and drink deeply 
of the lives of those in our care, for they 
are our fountain of youth, and their 
health and peace are our salvation. And 
at our journey's end, let the measure of 
our days be the chorus of thousands 
whose lives somewhere along the way 
were made more complete and more 
beautiful because, on this day, we 
became doctors. ■ 

those who cannot or will not fight for themselves, a 
promise to see all comers for what lies within, a promise 
never to abuse the trust that is given to us by those with 

Jeffrey Munson '01 is undertaking a residency in internal medicine 
at Yale-New Haven Hospital. 

and their respect, so rarely given in our time.// 




A young physician offers a lighthearted perspective on the trial 


the same scientists who eradicated smallpox and polio 
from the Western Hemisphere are working on a vaccine 
for HIV. You can rub shoulders with 11 different Nobel 
laureates, or get gross anatomy tips from world-famous 
surgeons like Judah Folkman and William Silen. But if 
you plan on attending classes at Harvard Medical 
School, you'd better bring your Visa card, because the 
cost of one year is $44,900, and they dorft take Ameri- 
can Express! 

Just think: if you'd invested that money in Oracle or 
Sun Microsystems, you'd be worth close to $2 million 
today. And if that's not depressing enough, consider this: 
Thomas Jefferson incurred less debt when he purchased 
the Louisiana Territory from the French back in 1803. 

Medical school took its toll on more than our bank 
accounts, however. As afternoon New Pathway 
naps gave way to 24-hour emergency room 
shifts, we began to experience the exsan- 
guination of our social lives. And you can 
always tell when you haven't gotten out in a 
while: like if the last movie you went to see 
was narrated by radiologist Lucy Squire; or if 
you thought The Matrix was something you 
grew fibroblasts on; or if the last four people 
you've dated get email from the "Quad Bulletin." You 
know who you are. I'll be the first to admit that the last 
time I placed my hand on a woman's chest for thrills was 
during a workup to rule out aortic insufficiency. 

I'll never forget the irony of Liam Neeson's line in the 
latest episode of Star Wars when he warned, "Training to 
become a Jedi isn't an easy challenge. And even if you 
succeed, it's a hard life." Yeah, cry me a river. Frankly, I'd 
like to see how Obi- Wan Kenobi holds up after missing 



David Joyce gave a 

humorous take on 

four years of medical 

school — and the debt 

that students incur 

during that time. 

yet another meal to go manually disimpact Jabba the 
Hut while being asked by his senior resident to summa- 
rize Ranson's criteria in 15 words or less. 

But I don't have to tell you guys about the challenges 
inherent in the profession we've chosen. You've all suf- 
fered through the eight-week stench of formaldehyde, 
the agony of the brachial plexus, and the pure torture 
that is commonly referred to as biochemistry. You've 
listened at lightning speed to the current understand- 
ing of Sonic hedgehog and struggled to keep your col- 
ored pencils in order as you contemplated the myster- 
ies of gastrulation. You've experienced the sensation of 
general anesthesia even as you sat in lectures on the 
same topic. 

As we remember the sacrifices we made to be here 

today, I hope we wall not forget the purpose behind 

our efforts ["Pomp and Circumstance" starts playing in 

the background]. Although we won't make as 

much money as our friends at the business 

school or enjoy the nine-to-five lifestyle of 

many of our colleagues across the river, we'll 

have the satisfaction of knowing that our 

efforts will relieve human suffering. Our 

reward for the long hours spent on call will be 

the smile on a young child's face after we... [pause, 

as he notices that a graduate has raised his hand] I'm sorry, do 

you have a question? 

Graduate: "When you have asthma, is it easier to 
breathe in or breathe out?" 

Hmmm, Bruce Zetter warned me about this... [speaking 
very fast] While the physiologic mechanism of reactive air- 
ways disease impairs the ability of air to be expelled from 
the alveoli, the subjective experience of the asthmatic is 
actually one of difficult inspiration. 

// Thomas Jefferson incurred less debt when he purchase* 




and tribulations of medical education by DAVID JOYCE 

Anyway, as I was saying, we have endured much to 
get where we are today. And now we are very close to 
being finished. 

How close are we? Well, let me put it this way: if 
medical school were Beethoven's Fifth Symphony, the 
first year class would be listening to this [sounds of 
an orchestra tuning] and we would be 
here [final notes of Beethoven's Fifth]. If 
medical school were the Boston 
Marathon, the tirst-years would be 
here [sounds of cheering] and we would 
he here [sounds of retching]. If medical 
school were the Kentucky Derby, we 
would be right here [sounds of a horse 
galloping] and the first-years would be 
here [sounds of a horse relieving itself]. If 
medical school were a Whipple pro 
cedure, the second-year class would 
be right here [suction noise with heart 
monitor beeping in the background of an 
operating room] and we would be here 
[suction noise with heart monitor beeping in 
the background of an operating room]. 

And finally, if medical school 
were this speech, we would be at the 
part where I say, congratulations on 
surviving what may have been the 
most difficult years of your lives. 
Never doubt that the gratification of 
serving other people is far more 
valuable than any material gain or 
personal achievement. Thank you, 
and keep in touch. ■ 

David ]oyce VI is undertaking a residency in 
general surgery at the Johns Hopkins Hospi 
tal in Baltimore, Maryland. 

rench back in 1803.// 











Physicians take intellectual, spiritual, and ethical 
stock of themselves and the state of their profession 


the podium at the Alumni Day Symposium, many in the audience must have 
wondered what language he was speaking. "Eraritjaritjakq, craritjaritjcikcC Charles 
Hatem '66, the Harvard Medical Alumni Association president, began. "I have erar 
itjaritjaka." Hatem, director of medical education at Mount Auburn Hospital, 
explained that this Australian aboriginal concept, meaning "filled with desire for 
something that is lost," was evoked by Belgian physician Joris Nauwelaers in his 
December 2000 Lancet essay lamenting the disappearance of the time-honored 
skills and practices of general medicine. In keeping with the symposium theme, 
"Strategies for Physician Renewal," speakers offered diagnoses and remedies for 
other ailments that commonly afflict today's doctors. ■ 

Tom Reynolds is a writer in the deans office at Harvard Medical School. 




A physician offers colleagues a prescription for finding both personal 


"I have craritjaritjaka. In fact I have had craritjaritjaka for 
some time, but it is becoming worse; that is why I felt I 
had to write about my condition — not only for my own 
sake (I'm not that important) but to help mankind." 

So wrote Joris Nauwelaers in a prize essay published 
in The Lancet last December. Eraritjaritjaka, a poetic 
expression in the language of the Aranda, an aboriginal 
tribe in Australia, means, "filled with desire for some- 
thing that is lost." 

What is our colleague lamenting? He 
mourns the loss of teachers committed to 
making the study of medicine a thrilling 
experience, of teachers who felt deeply 
responsible for the doctors they were making. 
He laments the loss of heroes, those who 
inspire us, who make us want to be like them. 
He is pained at the loss of the primacy of the 
patient's history, of the constriction of inter- 
viewing and physical examination skills. He 
is outraged at bureaucratic interference with 
medicine; and he shares with us Stanislaw Lee's reflec- 
tion, "There will always be Eskimos who would tell the 
Congolese what to do when the weather is too hot." 

Dr. Nauwelaers sees and feels all of this, and has crar- 
itjaritjaka. And so do we. As with pernicious anemia, in 
pernicious medicine, extrinsic issues are only part of the 
lesion. Intrinsic elements abound. For example, does 
anyone in the audience know any compulsive people? 

The obsessive -compulsive personality has some inter- 
esting characteristics. According to the Diagnostic and Sta- 
tistical Manual of Mental Disorders, these include: a preoccu- 
pation with details, rules, lists, order, organization, or 
schedules to the extent that the major point of the activ- 


ity is lost; a sense of perfectionism that interferes with 
task completion; an excessive devotion to work and pro- 
ductivity 7 to the exclusion of leisure activities and friend- 
ship; a reluctance to delegate tasks. 

There is no question about the upside of compulsive - 
ness, as in attention to detail in patient care or the pur- 
suit of a new idea. But it is the liability side of compul- 
sive behavior in physicians that demands attention, 
leading as it does to the belief on our part — and I must 
say on society's part as well — that we ought 
to make no errors. This same compulsivity 
also establishes us as excessively vulnerable 
to criticism (which is one reason, I think, 
why feedback — especially in medical edu- 
cation — is so tough). Left unmodified, com- 
pulsivity can indeed cripple. 

John-Henry Pfifferling, a medical anthro- 
pologist, writes poignantly about these mat- 
ters. Over a decade ago, he reported on his 
experience in dealing with some 1,200 physi- 
cians who had "lost" in their personal and 
professional lives. He asked them, "Given the difficulties 
that you now find yourself in, what do you wish you had 
learned in residency or medical school training?" Listen to 
their messages for us: 

• set life priorities and validate them with those 
personally important to you; 

• learn to nurture yourself, set realistic goals, and 
reduce your need for external validation; 

• seek and learn to enjoy solitude; 

• take regular vacations (Pfifferling proposes a line of 
vacation luggage called "Guilt," designed for small 
journals, big journals, laptops, cell phones, and 

the like); 

//Renewal is rooted in attention not only to our values, bul 



and professional fulfillment by CHARLES J. HATEM 

• understand your needs and the needs of your 
loved ones; 

• beware the consequences of overwork; 

• learn to deal with grief, failure, and disappointment; 

• learn to share your feelings; 

• learn how to say, "I don't know"; 

• let go of the need to rescue; 

• learn how to say no, and feel good about it; 

• leave your work at the office; and 

• recognize the dangers of self- medication. 

One is reminded, upon hearing this litany, oi what a 
participant said to management guru Tom Peters after 
one of his seminars. "You know, what you are talking 
about is a blinding case of the obvious!" The problem, of 
course, is the dissociative mismatch between what w e say 
and what we do. 

George Bcauchamp, a pediatric ophthalmologist who 
does medical management work, tells the story of the frog 
in a beaker being slowly heated. There is no response to 
the mounting thermal insult until the frog succumbs. 
Inattention to environmental toxicity leads to profession- 
al hypocrisy. Too often, we dispense advice about a bal- 
anced life that we routinely ignore. 

Renewal cannot be reduced to a single intervention; we 
must adopt a sustaining mindset. In the language of the 
day, primary prevention is the way to go, but we must 
remember that intervention at any time is appropriate and 
needed. We need to pay attention to the messages of Pfif 
ferling's physicians; we need to stay renewed professional- 
ly and to tap into the richness of current information 
sources in new ways. Professional and personal renewal 
are also available from outside the world of medicine. 
Renewal is rooted in attention not only to our values, but 
also to the attitudinal lens we use in viewing the world. 

Frederic Hudson, a psychologist working in the field of 
adult renewal, writes of core values as perspectives 
around which we can organize our lives and with which 
we can "reboot our systems." There is, for starters, the 
"Who am I?" question. There is a growing sense of the role 
of spirituality in medicine and the need for a spiritual 
awakening among physicians. This is not meant in the 
religious sense, though it by no means excludes it. Rather, 
1 mean spiritual in the context of a commitment to a larg- 
er set of transcendent values as a framework for what we 
do, as a key part of the front wheel drive in our lives. 

The connecting piece comes from the reaffirmation of 
personal values. Barrie GreiK, a psychiatrist, writes of trav- 
eling with his daughter in Vermont and seeing the sign, 
"Asparagus for sale." Upon meeting the farmer, and being 
imited to tea, Greiff learns of his host's end-stage myelo- 
ma, which has brought him to this place, where he stocks 
the pond and replants the soil. This replenishing of life 
represented for the farmer part ol his legacy, part of his 
value system. Greiff connects this experience with the 
notion of the ethical will. Such actions convey to one's suc- 
cessors a statement of life values and perspectives to be 
cherished. So, think for a moment. What are your values? 

Sharon O'Malley, contributing editor to the Quality 
Letter, describes the power ol "naming the things that go 
to the core of where we find our sense of meaning.. .in our 
work lives. What do you value deep down to your toes? 
We see people begin to recognize that their core values 
equate to core purpose." Within this core perspective of 
reaffirming personal values is clearly a commitment to 
family and friends. Our commitment to those close to us 
can shp aw : ay unless it is tethered to our values. Our com- 
mitment to colleagues likewise needs cultivation as a 
vehicle for mutual support and renewal. 

also to the attitudinal lens we use in viewing the world.// 



Within the reaffirmation ol personal values is the need to 
be dear about the role ol play and creativity in our lives. 
Remember our colleagues 1 admonitions about vacations. 

Short ol these respites, finding time tor renewal in other 
non physician parts ol our lives is essential, but again often 
put on hold. No doubt, literature is one such resource, given 

the pleasure ol literature on its own merits as well as the 
power ot writing to help us understand the care ol patients 
in a way that no textbook has the power to do. 

We also need to be renewed through the reaffirmation 
ot our professional values. The affirmation ot Fundamen 
tal ideals is well captured in the Patient Physician 
Covenant, which talks ot humility, honesty, intellectual 
integrity, compassion, and the ettaeement ot excessive 
sell interest as traits that mark physicians as members ot 
a moral community dedicated to something other than 
its own selt interest. 

Renewal is further to be found in real tinning the privi 
leges and prerogatives ot practice. Think ot patients who 
have moved your soul. And 1 mean patients — not clients, 
customers, or units ot productivity, but patients' 

The question comes to this: Are we prepared to reaffirm 
that which gives us joy in our work? Pfifferling makes an 
interesting point in this regard: "If 'negative' feelings such 
as anger and tear are suppressed." he argues, "then the abil 
ltv to teel love and joy is also incapacitated." Remember 
T. S. Eliot's admonition: "We had the experience but missed 
the meaning." Real tinning the value ot our work is the 
essential ingredient in renewal. 

John Gardner, a long time observer of the health care 
scene, savs. "1 can tell you that tor renewal, a tough minded 
optimism is best." It is easy to be cynical and indeed, Gard 
ner suggests that perhaps, "Pessimists got that way by 
financing optimists." Strip away the rhetoric and recognize 
how powerful this advice is: putting life's mischief in con 

text is liberating, sustaining, renewing. Dampen the anger. 
w Inch is a corrosive lubricant in dealing with the world. 

We have seen this most Fundamental challenge ol cali 
brating attitude throughout history Franklin Delano Roo 
sevelt, presenting in his radio fireside chats the key themes of 
his presidency — the New Deal, the economic pain of the 
Great Depression, and World War 11 — shaped this most 
basic message. In times like these, attitude is everything 

We have repeatedly seen this matter of freedom to choose 
one's attitude in any given set ol circumstances as the key to 
success: from the life ol Nelson Mandela to John XXIII, who, 
at age 76, was elected pope and stood the Catholic Church 
on its head. His attitude on life was disarming yet balanced. 
1 le advised that one see everything, overlook most ol it, and 
change a little. 

Rut I do not wish to suggest that this mindset belongs 
only to the exceptional. We see it regularly in our patients, 
who persevere despite enormous burdens. We should 
attend to the lessons they teach us. So here, my good, list 
keeping, guidelines directed colleagues, is a template, the 
key to the course. Ptitterling's accounting ot the traits of col- 
leagues who stay joyful despite ambient toxicity are as fol 
Lows: a sense of humor; strong support from those we love, 
our friends, and our colleagues; clear values; collegialitv; and 
awareness ot personal needs. 

Sound simple? Sound like the soft stuff? Remember, my 
colleagues, that we dispense tins advice regularly. Come on 
now! Down with professional hypocrisy! Up with listening 
to ourselves! Sa\ e some of your daily ATP production for 
yourself and those close to you. Your work will be enhanced. 
This is not selfishness, but self preservation. 

Be renewed! ■ 

Charles /. Hatan '66 is director oj medical education at Mount Auburn 

Hospital in Cambridge, Massachusetts. 

further reading 

Beauchamp GR. The Five "S" 
Levels of Enterprise Health. The 
Physician Executive 1999;25:25-29 

Cassel C. The Patient-Physician 
Covenant: An Affirmation of 
Asklepios. Ann Intern Med 

Davies R. The Cunning Man. 
Viking Penguin, 1995 

Edson M. Wit. Farrar, 
Strauss & Giroux, 1 999 

Gardner JW. Personal Renewal. 
West J Med 1992,157:457-459 

LaCombe M. Playing Cod. Ann 
Intern Med 1992;116:161-162 

Nauwelaers J. Eraritjaritjaka. The 
Lancet 2000;356:2169-70 

Noonan P. Speaking Well. Regan 
Books, 1998 

Pfifferling J-H, et al. Putting "Life" 
Back into Your Professional Life. 
Family Practice Management, 
June 1999 

Sanders B. Fabled Service: Ordinary 
Acts, Extraordinary Outcomes. 
Jossey-Bass Publishers, 1 995 

Clever LH. Designing An Action 
Plan for Change: Personal and 
Professional Renewal. ACP-ASIM 
Annual Meeting, 2001 

Crawshaw R, et al. Patient-physi- 
cian covenant. JAMA 

Greiff BS. Legacy: The Giving of 
Life s Greatest Treasures. Regan 
Books, 1999 

Handy C. The Hungry Spirit. 
Broadway Books, 1 998 

Hudson FM. The Adult Years: 
Mastering the Art of Self-Renewal. 
Jossey-Bass Publishers, 1999 

Nuland S, quoted in "Medicine 
and Mystery," Boston College 
Magazine, Winter 2001 

Pfifferling J-H. Things I Wish They 
Taught in Medical School. Resident 
& Staff Physician 1990;36:85-92 

Selzer R. Letters to a Young Doctor. 
George Borchardt Inc., 1982 

Sulmasy D. Is Medicine a Spiritual 
Practice? Acad Med 1 999 

Weinberg RB. The Laying On of 
Hands. Ann Intern Med 


How can physicians use the information revolution to renew 
themselves and improve care? by ROBERT H. FLETCHER 

i m 


gave grand rounds on finding clinical information, 
an older physician came up to me and 
"How i- that electronic textbook you mentioned 
doirj' [f I didn't have it. I would have to stop 
practicing medicine'" 

>e. renewal outside of work is very 
important I recharge my batteries with carpen- 
try, stone wall building, sailing, gardening — and 
I'd do a lot more if I could find the 
time. But we phvsicians spend so much 
of our rime at work that any balanced. 
complete view of renewal must 
include that rime too. 

Actively embracing the information 
revolution — as that older physician 
has — is part of physician renewal. It 
can make work more fun. interesting. 
and comfortable in these overcharged 
times. Standing pat and hoping to ride Robert Fletcher 
out the changes is bound to compound 
the distress 

Let's begin by admitting that we need help. The 
information required to practice medicine used to 
fit comfortably into an ordinary brain. When I was 
a resident and had a patient with acute pulmonary 
edema. I could mentally sort through the therapeu- 
tic options without difficulty: phlebotomy, rotat- 
ing tourniquets; mercury injections (perhaps with 
aminophylline): and morphine. That was it. .And it 
was usually simple to decide what to do: use all of 
them and hope that would be enough. 

Now the options are so rich and varied that it 
can be difficult, if not impossible, to commit many 

conditions and their treatments to memory and 
carry them around in our heads. 

Take, for example, the treatment of HIV infec- 
tion. The recommended drug regimen has grown, 
just in the past few years, to include several class- 
es of drugs, and several options within each class. 
Patients must, without fail, take three different 
drugs to which their \ir. .rive if thev are 

to keep the virus in check. 

How do we wTap our brains around 
all of this information? Those of us in 
one of the big teaching hospitals, with 
so many experts close at hand, may feel 
we can handle things simply by con- 
sulting our colleagues. But one does not 
: - mailer hospitals, to 
offices in the communitv :rom 

HMS — to unmask the problem. 

Well you might say. such pat:, 
should be under the care of a specialist 
who really does know all those things 
cold. Sure, but what if that clinician, let's s 
HIV specialist, needs to adapt his or her care to the 
oncologist's management of malignancies compli- 
cating immunosuppression? Or of the lipid disor- 
ders that antiretroviral drugs cause? Commanding 
an almost impossibly broad array of information is 
a problem not only for generalists like me. 

Fortunately, now there is help for cliniciar 
our own terms. As clinicians, we must be able to 
xess information quickly, usually within sec- 
onds, if we are to use it in a busy practice at the 
time clinical decisions are being made and teach- 
ing done. If we do not find answers immediately. 

//Clinicians must be able to access information quickly.// 


we arc likely not to find them at all. Wc 
nunc on to other patients and do not 
return to the original question. At the end 
of the day, we arc tired or have something 
else, perhaps even something renewing, we 
want to do. So in a moment we can lose an 
opportunity to do better by our patient, or 
a student working with us. 

Clinicians need current answers — at 
least for the fields that are changing fast, 
such as the diagnosis and treatment of 
emerging infections. Also, the information 
should be sorted by scientific strength, so 
that highly credible studies — for example, 
large randomized trials — stand out from 
weaker clinical research, good basic science 
that is not yet ready for clinical use, and 
simple opinions. 

Nowadays, we can find the best available answers to 
clinical questions within seconds in a number of ways. Let 
me give you a few examples. 

The textbooks on most physicians' shelves date back a 
long time, their contents unchanged since publication, 
though the evidence base for medicine has changed. A new 
generation of electronic textbooks is helping to over- 
come this problem; Scientific American Medicine, 
under the leadership of Daniel Federman '53 and 
David Dale '66, is updated regularly. Another e- 
text, called UpToDate, also by Harvard faculty, is 
a library of internal medicine and subspecialty 
texts, the equivalent of 40,000 printed pages. 

With these new kinds of resources, readers not 
only stay fully current, but they can also experience 
the color, movements, and sounds of medicine. They can 
see variations on a heliotrope rash, watch a slapping gait, 
or hear a midsystolic click. 

A number of clinician-scholars throughout the world 
have organized themselves into working groups, collec- 
tively called the "Cochrane Collaboration," that gather the 
best information on the effectiveness of interventions. 
Members search all of the world's journals for randomized 
controlled trials and send summaries of studies that meet 
rigorous criteria to a central location in Oxford, England. 
There it is synthesized and made available to everyone, 
everywhere in the world, free of charge (at least for the 
abstracts) through the Internet. 

Many of us find guidelines useful — not only the advice 
but also the critical reviews of the evidence standing 
behind recommendations. But how can you find the guide 
lines you want — and the others you don't even know 
about? Now all guidelines are listed on a single website: 

There are also one-stop websites for finding patient 
support groups, recommendations by the Centers for Dis- 
ease Control and Prevention for international travel, cur- 
rent antibiotic resistance by infectious agent and region, 
and much more. 



Robert Fletcher urges 

all physicians to keep 

pace with the flow of 

information available 

through electronic 


Clinicians also need to keep up with new developments 
in their specialties. It might seem sufficient to read an 
excellent general journal or two, along with a few of the 
best journals in a particular specialty. But actually, the key- 
articles in a field are much more widely spread out. An 
internist would have to review five journals to be familiar 
with half of the "can't miss" articles published in internal 
medicine each year and 14 journals to see 90 percent 
of those articles. 

It would be impossible for us, acting as indi- 
viduals, to do this, even with unusual dedica- 
tion and effort. We need help. Fortunately, oth- 
ers are now doing the heavy lifting for us. For 
example, the ACP Journal Club selects, by- 
explicit criteria, the most scientifically credible, 
clinically applicable articles from the world's litera- 
ture, boiling 6 million articles per year down to about 
200. A growing number qf newsletters are providing simi 
lar services in various specialties. 

In the past, our brains were black books (for facts such as 
differential diagnoses and drug doses) and packets of cards 
(one card for each ward patient). Now our students are 
finding ways to make a vast amount of information 
portable. My son, a medical student, has on his garden-vari 
ety PalmPilot (which holds the equivalent of about 3,000 
pages of printed text) textbooks, course syllabi, drug data 
bases, templates for write ups, and much more. He views 
my own efforts at information management with a mixture 
of pity and amusement. He cannot understand why I don't 
find better and easier ways to cope, as he has. 

Can we afford the time it takes to make these new infor 
mation sources part of our lives? I think we cannot afford 
not to. 

To illustrate, one night a colleague of mine was called 
about an abnormal prothrombin time, drawn that after 
noon, on an elderly patient on warfarin. The prothrombin 
time was dangerously high. He decided that the patient 
should receive vitamin K by injection right away, but it was 
late and she wouldn't come in to the hospital to get it. 
He was about to send an ambulance when he thought, "I'll 



just check that new textbook on my home computer." He 
learned of recent evidence that at the level of this woman's 
prothrombin time, it would be good practice to give oral 
vitamin K. A local pharmacy delivered the drug to the 
woman's home and she subsequently did well. He was able 
to give care that was safe and a lot simpler. 

The information I am describing is available to patients 
too. Without much difficulty patients can gather from the 
web more facts, good and bad, about their own diseases 
than their physicians are likely to have in their heads. That 
is good, in a way. But it does change the clinical relation 
ship. It pushes us to find new ways to add value to the clin- 
ical encounter — for example, by interpreting evidence, 
putting it into context, and suggesting credible sources of 
information. We must be prepared to recommend good 
websites in place of the weak, self-serving, or promotional 
sites patients might have found on their own. 

As we take up new habits in the information age, we 
must know exactly what we want to accomplish. We are 
seeking renewal, not just ways to get more 
done at the same breakneck speed. If we 
gain effectiveness and efficiency by wiser 
use of new information technologies, then 
use up the time saved trying to get that 
much more work done, we will be back 
where we started and just as much in need 
of renewal. 

Harvard Medical School is, of course, 
very much on top of the information revo- 
lution. In typical fashion, HMS has not 
added new, how-to courses to its curricu 
lum. What the School is doing — and this 
very vigorously — is creating an environ 
ment in which the best information is 
available by the most modern means. Then 
the School lets learning take its course. 

A new, web based resource, the eCom 
mons, has been built as the electronic 
equivalent to the New England town com 
mons — as a place where students and fac- 
ulty can meet to exchange information. 
They are, after all, physically dispersed — in 
the Quadrangle, in the teaching hospitals 
in Boston and Cambridge, and in teaching 
practices in the community. The eCom- 
mons helps them keep up with each other. 

On the eCommons is, among many 
other things, the Countway Library's 
extraordinary electronic collection of 
books and journals, as well as information 
from the Human Genome Project, which it 
shares with the HMS community every- 
where through its digital library. The 
newly renovated Countway is a wonderful 
place to visit. But we need the resources of 
the Countway far more often than we can 
physically get to the library. 

Through the eCommons, students and faculty are 
becoming familiar with information sources that are avail- 
able not only at HMS, for those of us who remain at the 
mother school, but anywhere in the world, to anyone with 
access to a phone line or a satellite dish. 

To get to the point where new sources of information do 
more good than harm, we must invest time to learn about 
the truly useful websites and devices. That would be a new 
habit for most of us. By investing, I mean being on the look- 
out for new possibilities, suggested by credible colleagues, 
and trying them out. Surfing the Internet or responding to 
for-profit promotions is not efficient. 

Such investments of time can help you to be buoyed up 
by the rising tide of information — rather than washed 
away or submerged by it. Information management should 
be a vital part of a physician's overall plan for renewal. ■ 

Robert H. Fletcher '66 is professor of ambulatory care and prevention 
at HMS. 




A physician-writer reflects on the curative powers of looking within to achieve 


month period, he had lost his job, his wife, and his literary 
agent. He had arrived at a point in his life when, after 20 
years in medicine, he felt burned out and ready for a 
change. Suddenly adrift, he became aimless, confused, 
unfocused. His agent, having learned of his first two losses, 
had dropped him like a wet diaper. Writing is a business, 
after all, and the agent knew, more than he did, what was 
to come. The man could no longer write, did not write for 
a year or more. Yet, somewhere in his con- 
sciousness he knew that writing was some- 
how key to his survival. What he had not 
learned was that medicine was also a part of 
his soul. He was clearly in need of physician 
renewal, although at the time he called it 
something else. 

Staring at the blank page, unable to pro- 
duce, still he did not miss medicine's unremit- 
ting demands. He did not miss being all things 
to all people, the final arbiter, the father con- 
fessor, the place where the buck would always 
stop, the captain of industry. Unfettered from these 
demands, he experienced a fresh feeling of freedom and 
believed he was well rid of her, Medicine. 

In this time away from medicine, if he could not write, 
he could still read. And so he read. Through Emma Bovary, 
he saw the great error of a life bent on material acquisition. 
In Edmond Dantes, he tasted the bitterness of a life dedi- 
cated to revenge. And in Jean Valjean and Bishop Myriel he 
saw lives of integrity, dedicated to the Good Thing, and 
sensed there might be something there for him. 

When he awoke from the fictive dream and returned to 
the light, he found there were bills to be paid, and a life still 
to be lived. Very well, he would use medicine, take any job 


that came along, do anything required to support himself 
as a writer. This was, he told me, the "IMG phase" of his 
career, his period of servitude as a locum tcncns, when he was 
assigned a desk in the nurses' lunchroom, treated with sus- 
picion, believed to be hiding gin in the bottom drawer. 
used, ignored, marginalized. He lived this life as long as he 
could, feeling his anger build, feeling the writer's block 
grow. But he had not been trained to be a gatekeeper, had 
never learned to be a provider, could not treat patients as 
cattle, could not punch out at five o'clock. 

He quit his job. And now he had a new wife 
who understood. "Good!" his wife said. "What 
took you so long?" He licked his wounds and 
read some more. Here is what his reading 
revealed to him: Honesty is fitting words to 
actions. Integrity is fitting actions to words. Our 
actions define us; not principles, not goals, not 
titles, not academic rank. 

Approach each patient with this thought in 
mind: I will learn one new thing from this person. 
Study medical history. Find your place in it. 
Cultivate your teachers. Have them teach you how to learn, 
not spoon-feed you. Cultivate your consultants. Do not 
abuse them. Send them the baffling case you cannot diag 
nose by your own wit. Do not, out of sheer laziness or 
crunch of time, send headaches to the neurologist, chest pain 
to the cardiologist, and arthritis to the rheumatologist. 

Cultivate your students. Do not try to make them into 
your own image for purposes of self- affirmation. You will 
harm them in doing so. Bother to find out what they need 
and want to do, and what they are capable of. For students, 
as for children, quality time is all that is required. 

Just as you cannot cure all disease, you cannot be a doc- 
tor to all patients. For your own peace of mind and for the 

// He knew that writing was key to his survival. What 




personal and professional balance by MICHAEL A. LACOMBE 

well-being of patients, you must learn to say "no," and "1 
am sorry but I cannot help you," and "I think it is time 
you saw someone else." These may be the most difficult 
words for physicians to say, reared as they are in a world 
that promises omnipotence and endless possibilities. 

Communicate. Imagination is the great demon of 
marriages, partnerships, universities. 

When in doubt, return to first principles. Take a 
history. Examine the patient. Talk to the family. Ask 
the nurse. 

Simplify your life. Thoreau was right: material pos- 
sessions will possess you. Acquire an object for its util- 
ity, not its appearance. Measure your worth not in 
objects, but in knowledge and in kindness to others. 

Remember these things: Love work, despise official 
dom, and do not make yourself known to those in polit 
ical authority. And this: all that is required for evil to 
triumph is for good people to do nothing. 

For God's sake, stop pitying yourself. You are not at 
the mercy of a despotic king. You are neither bound by 
class, nor diminished by poverty. You have great science 
as a tool, not leeches. The excellence of your pharmacy 
dwarfs arsenic, antimony, belladonna. Your citizenry in 
the richest, most advanced country in the history of the 
world is sheer good fortune. You do not live in Uganda. 
You enjoy more than an ox for transportation. Your 
children will almost certainly reach adulthood. 

Stay in shape. This means more than mere diet and 
exercise. You need a diet of poetry and literature, and rig 
orous exercise in thinking and in spiritual contemplation. 

Being a doctor requires quick reflexes. The occasion 
is instant. Hone your reflexes by a regular habit of 
exposure to patients, talking to them, touching them, 
taking a history, and doing a physical examination. 

Learn how to listen. You cannot understand another, 
nor take a meaningful history, by talking. 

Avoid arrogance. In the great panoply of human his- 
tory, what have you to be proud of? We exist for each 
other. Teach others, care for them. Generosity, that's the 
key. When you begin to become overly proud, when 
you begin to strut and show, ask yourself this: With the 
tools available at the time, would you have been capable 
of the observation and description of Hippocrates, the 
precision and analysis of Sydenham, the auscultatory 
skill of Laennec? 

Offered a job because they needed him, the physi- 
cian writer took the position because it felt good to 
be needed again. But because of the sort of doctor he 
was, because of his excellence in training, soon he 
became all things to all people, the final arbiter, the 
father confessor, the place where the buck could 
always stop, the captain of industry. For a time it felt 
good. He had missed these things, missed the mantle 
of their importance. Soon he was working full time, 
then more than full time, still living a life unbalanced 
and therefore, for him, an unhappy one. Moreover, 
there was corruption at this job, the corruption of 
corporate medicine, of takeovers and payoffs. He had 
a choice. He could be a Danglars, keep his head down, 
remain on, and profit. Or be a Jean Valjean, speak out, 
and so place himself in jeopardy. 

"I quit my job," he told his wife. 

"Good!" she said. "What took you so long?" 

He was beginning to learn what it was he wanted: a life 
in balance. A life of literature and writing. And of medi- 
cine. Not the medicine of the twenty-first century, but 
rather the medicine he had learned to love. And so, though 
a generalist, he passed himself off as a specialist. In the 

had not learned was that medicine was also a part of his soul.// 




process of becoming a specialist, on his own time, at night, 
and on the job, he had to learn new things. As a result his ful- 
fillment grew. He remembered a passage he had read long ago: 

"The best thing for being sad," replied Merlyn, begin- 
ning to puff and blow, "is to learn something. That is 
the only thing that never fails. You may grow old and 
trembling in your anatomies, you may lie awake 
at night listening to the disorder of your veins, 
you may miss your only love, you may see the 
world about you devastated by evil lunatics, 
or know your honor trampled in the sewers 
of baser minds. There is only one thing for it 
then — to learn. Learn why the world wags 
and what wags it. That is the only thing 
which the mind can never exhaust, never alien- 
ate, never be tortured by, never fear or distrust, and 
never dream of regretting. Learning is the thing for 
you. Look at what a lot of things there are to learn: 
pure science, the only purity there is. You can learn 
astronomy in a lifetime, natural history in three, liter 
ature in six. And then, after you have exhausted a 
milliard lifetimes in biology and medicine and theo- 
criticism and geography and history and econom- 
ics — why, you can start to make a cartwheel out of 
the appropriate wood, or spend 50 years learning to 
begin to learn to beat your adversary at fencing. After 
that you can start again on mathematics, until it is 
time to learn to plough." 

Resisting every form of enticement, financial and other 
wise, he insisted upon this life in balance. Half of his time 
he would thrill to patients and the passing of catheters, 
wires, and lines, and with the other half, quicken at the 
magic of the written word. His wife, seeing him happy, was 
herself happy. He found he had to struggle with shifting 
gears, every week jumping from the left brain world of 
medicine to the right brain world of creativity. In this 

Michael LaCombe 
touches on the dangers 
of not listening to your- 
self and the rewards 
of living a life in 

shifting of gears, he found that he possessed two souls, and 
the true secret of renewal, of staying power. 

Thus began, he tells me now, his "working- mother phase," 
a time when he tolerates whispers of "He works only part 
time," and "He takes four days off every week." He also lives 
a life of not being all things to all people, a life where he is not 
the final arbiter, but relegates that role to someone else. He 
is no longer father confessor, no longer the place where 
the buck always stops, no longer the captain of 
industry. When he finds himself missing these 
things, he reminds himself of their cost. And when 
he is asked by someone, in inflected condescen- 
sion, what it is that he does with all that time off, 
he smiles and says, "I do research." 
Still, he has moments, he tells me, when he 
wonders why he is here and what it is his life is real- 
ly all about. At these times, he says, he compares himself 
to the poet watching mayflies, who writes: 

Watching those lifelong dancers of a day 
As night closed in, I felt mxsclf alone 

In a life too much my own. 
More mortal m my scparateness than they — 
Unless, I thought, I had been called to be 

Not fly or star 
But one whose task is joyfully to sec 
How fair the fiats of the caller arc. ■ 

Michael A. LaCombe '68, a physician and writer, is director of cardi- 
ology at the Maine General Health Center in .Augusta, Maine. 

Merlyn quote excerpted from The Once and Future King, by T. H. 
White (reprint edition 1996), reproduced by permission of Putnam 
Penguin. All rights reserved. 

Excerpt from "Mayflies" in \ layflies: New Poems and Translations, 
1 2000 by Richard Wilbur, reprinted by permission ofHarcourt, Inc. All 
rights reserved'. 



How should academic institutions manage conflicts of interest in 
biomedical research? I by JOSEPH B. MARTIN 


over the past century. The academic mission is edu- 
cation and discovery driven by intellectual curiosi- 
ty — what we in academia like to call "pure 
motives." In industry, the mission is translational 
research, commercialization, and profit making. 

Yet during the course of the century, a sequence 
of breaches in the wall separating these two cul 
tures has developed. The first breach arose around 
technology, engineering, and computer 
science, which led to a deliberate 
process of issuing patents, licensing 
them, and earning royalties. Discovery 
occurred in university laboratories, 
which owned the patents, and devel 
opment occurred under exclusive 
licensing arrangements in industry. 
Most major research universities 
engaged in the fundamental sciences 
followed this sequence. 

During the past 50 years, with feder 
al support for biomedical research growing at an 
incredible pace, we have watched the same process 
occur in the biological sciences. But new ethical 
issues have emerged. In addition to technology, in 
the biomedical sciences we are dealing with agents 
and devices that are put into people and are tested 
for efficacy and safety before being approved. 

To facilitate this translational research, academic 
institutions have over the past two decades devel- 
oped an understanding with their faculty, which I 
call the "20 percent rule." We allow, and even 
encourage, our faculty to engage in outside activi- 
ties for up to one day a week, activities for which 


they can be remunerated by honoraria, consultant 
fees, stock options, and equity. They can start com- 
panies and be entrepreneurial, and we have come to 
admire those who have been very successful, includ- 
ing a number of our most illustrious faculty. 

Another development expanding the breach in 
the wall has been the evolution of basic science 
support from industry to our academic laborato- 
ries. It began notably with the Monsanto deal 
at Washington University in the mid- 
1970s. Here at Harvard, a proposal 
from Monsanto in 1972 to support 
the work of Bert Vallee and Judah 
Folkman '57 resulted in a prolonged 
discussion about technology licensing 
and patents. Harvard relented and 
opened a patent office for the first 
time in 1977. Subsequently, the 
Hoechst arrangement with Massachu- 
setts General Hospital was formulated 
in the early 1980s to support molecular 
biology. MGH also now has a major deal with Shi- 
seido, a Japanese cosmetics company, to support 
research in cutaneous biology. The Dana-Farber 
Cancer Institute has deals with Novartis. Across 
the country, we have watched controversial rela- 
tionships at the Scripps Research Institute with 
Novartis, and most recently, the involvement of 
Novartis in plant genetics at the University of Cal- 
ifornia at Berkeley. By and large, each of these rela- 
tionships has been controversial in the beginning, 
but we have come to live with them. 

In the last five years, yet another breach has 
occurred. We have recognized that our institu- 

//Faculty can start companies and be entrepreneurial.// 



tions do not actually make much money from royalties. 
Only a few institutions in the country earn more than $15 
to $20 million a year through their technology transfer 
offices. So our academic institutions took action to accept 
equity in new companies as a way to enhance the econom 
ic value of their intellectual property. This followed the 
recognition that many start-up companies have become 
very wealthy, and that owning stock in them increases the 
chances of enhancing financial returns from the agree- 
ment. Most of our large fellow institutions — such as 
Columbia and Johns Hopkins — now also accept equity in 
start-up companies, as do Harvard and most of our affiliat- 
ed hospitals in the Boston area. 

During this time, opportunities in clinical research have 
grown enormously. The number of clinical trials has 
increased dramatically, as has the support from industry 
for clinical research. A good number of clinical research 
organizations, both for-profit and not-for-profit, have 
formed in the past five years. More Harvard faculty are 
now involved in clinical trials; we have watched the Insti 
tutional Review Board (IRB) workload increase. Ten years 
ago the promise of gene therapy led to aggressive clinical 
trials, which were complicated when investigators began 
introducing into people complex biological agents whose 
effects are unpredictable. As we saw with the tragic death 
of Jesse Gelsinger at the University of Pennsylvania, aber- 
rant and unexpected immunologic events can rapidly 
result in death. 

Breaches in the wall between industry and academia 
might be considered advantageous to us all for a number of 
reasons. Translational research has facilitated growth hor- 
mone therapy, advances in angioplasty, and technologies like 
fMRI. Interdisciplinary opportunities have been enhanced. 
Here at Harvard, for example, the new Institute of Chem 
istry and Cell Biology was supported with a $5 million gift 
from Merck. It was a nonexclusive arrangement; Merck had 
no particular rights, but it believed that what we were 
doing was vital and therefore worthy of funding. 

Discretionary money for academic programs 
also has been important for our institution and 
has funded professorships, fellowships, and 
scholarships. The acculturation between the 
academic and industrial communities has cer- 
tainly been one benefit from these interactions 
over the years. But the increasing number of these 
new relationships and the challenge inherent in man- 
aging them has led us to stop and assess what we are doing 
and permitting. 

We have heard about the "university for sale" (Marcia 
Angell) and "uneasy bedfellows" (David Weatherall). We 
have watched our leading institutions charged with inade 
quate compliance with informed consent; we have seen 
institutional review boards perceived as acting out of self- 
interest and not always asking the questions they should; 
we have witnessed the expansion of federal regulations 
and threats of fines for noncompliance. Other concerns 
about conflict of academic interests persist: the question of 


Joseph Martin 

believes that clear 

policies and full disclo 

sure are crucial for 

avoiding conflicts 

of interest in 


whether students are free to pursue their own research 
interests; publication delays and manuscript debates that 
result from research findings that do not come out the way 
a sponsoring company wanted; and the general worry 
about the loss of academic exchange in an environment in 
which this research is supported by for-profit entities. 
About two years ago we were faced with the question of 
what Harvard Medical School's position would be on 
financial conflicts of interest. In 1991, the faculty had 
embraced a new set of guidelines, which permit 
ted income of $10,000 in consulting fees and 
ownership of up to $20,000 equity in a publicly 
traded company, even when that company sup 
ported research in the investigator's laboratory. 
Eugene Braunwald, vice president for academic 
programs at Partners HealthCare System, chaired a 
committee of the faculty that deliberated effectively and 
passionately over this issue for a period of about 18 months. 
The committee was split in its recommendations. The possi- 
bility of a majority report versus a minority report emerged 
when I recognized, with the death of Jesse Gelsinger, that we 
should hold to our rather strict guidelines and wait to see 
whether a national consensus would develop with respect to 
how we might proceed. 

What has happened since then? The best data available 
on the nature of these issues appeared in several papers in 
JAMA and the New England Journal of Medicine last fall. These 
data showed widespread variability in guidelines, monitor - 



ing, and faculty awareness of issues linked to actual or per- 
ceived conflicts of interest. 

Dennis Kasper, HMS executive dean for academic pro- 
grams, and I summarized our thoughts on this topic in the 
November 30, 2000 issue of the New England Journal of Medicine. 
We believe that the public deserves: 

• to know that the research they support will be a search 
for truth uncontaminated even by a perception of bias; 

• to see that discoveries with the potential to improve 
health are rapidly translated in practice to clinical trials; 

• to feel confident that their participation in the develop- 
ment of new therapies will be safe, with full informed 
consent obtained at the outset and access to outcome 
data provided afterward — something that I think we 
rarely do in clinical trials; and 

• to be assured that neither the decision to ask patients to 
participate in clinical trials nor the assessment of the 
risks that patients may incur will be prejudiced by an 
investigator's personal profit motives. 

Last fall, we convened the leaders of about 20 of the top 
medical schools, both private and public, that are supported 
by the National Institutes of Health. We divided our recom- 
mendations into three general categories. The first category 
involves institutional policies. We encourage institutions to 
develop both widely understood disclosure pohcies for facul 
ty and researchers, and a process for review and management 
of any issues that may arise from the disclosure. Every med- 
ical school research institution should have a written policy 
on financial interests related to research. The policy should 
include a statement of general principles and a clear delin- 
eation of the kinds of financial relationships that are and are 
not permissible, or that require review or approval. 

Importantly, the policies should specifically address 
the special circumstances surrounding clinical research. 
Except under extraordinary circumstances, people directly 

involved in the conduct, design, or reporting of research 
involving human subjects should not have more than the 
clearly defined minimal personal financial interest in the 
company that sponsored the research or owns the technol- 
ogy behind the study. The majority of the group wanted 
this to be a "zero" rule; in other words, no financial inter 
est in the research or technology would be permissible in 
clinical trials. A minority preferred to leave this up to the 
individual institution. 

The second category is the disclosure of financial inter- 
ests. We believe that all faculty, trainees, students, and staff 
who participate in research should be required periodically 
and prospectively to disclose related financial interests. Fac- 
ulty, trainees, students, and staff who participate in clinical 
research should disclose financial interests to institutional 
review' boards. Each IRB should have responsibility for 
ensuring that patients are informed of such relationships as 
the IRB deems appropriate. Finally, faculty, trainees, stu- 
dents, and staff should disclose all related financial interests 
in any publications or oral presentations. 

The third category of recommendations concerns imple- 
mentation and review. Disclosure should be made on multi 
pie levels within each institution, not only to the depart- 
ment chairs, but also to the dean, chief executive officer, or 
equivalent individual who has ultimate responsibility for 
monitoring the activities of faculty, staff, and students. The 
group strongly believed that simply reporting to the division 
head or the department chair would not suffice; the depart- 
ments in many cases have much to gain from activities that 
might concern the institution itself. The group recommend 
ed that each institution have an advisory oversight commit 
tee that brings together faculty, administrative staff, and rep- 
resentatives from the community at large. This committee 
should be charged with providing oversight, reviewing all of 
the difficult cases, and establishing monitoring procedures 
for exceptional cases when appropriate. 

Collaboration between our academic institutions and the 
industrial world is essential. The public benefits from this 
collaboration. The drugs and devices that we take for grant- 
ed and are thankful for have been the result of the relation- 
ship between the academic and industrial communities. 
Faculty members are often energized by collaboration and 
become more entrepreneurial and productive as a result. The 
public will, however, lose trust in our institutions if we fail 
to monitor these collaborations. 

The benefit of these relationships is that they facilitate 
what we are all here to do in the end, to find treatments for 
the ills that afflict humankind. As we define it in our mis- 
sion statement for Harvard Medical School; "To create and 
nurture a community of the best people committed to lead- 
ership in alleviating human suffering caused by disease." 
The unfortunate part is that real or perceived conflict of 
interest, personal or institutional gain, and personal 
enrichment and fame may contaminate the search for and 
discovery of Veritas. ■ 

Joseph B. Martin, MD, is dean of Harvard Medical School. 




Members of the Class of 1976 celebrate and lament how technology 


their four years at HMS at the Class of 1976 
Symposium. "We came. We sat. We listened. We were 
tested. We passed," said Maria Savoia, professor of 
medicine at the University of California, San Diego 
School of Medicine. "We went to the wards. We saw 
patients. We turned in reports. We matched. We left." 
The lives of many graduates have become more excit- 
ing — and even turbulent — in the intervening 25 years, 
judging by the majority of presentations at the sympo- 
sium. Casting but a brief look at their shared past, 
speakers launched into up-to-the-minute reports from 
a wide variety of medical fronts. There was a sense of 
urgency as they described how unprecedented changes 
in technology are transforming their profession. From 
classroom to clinic, the world of medicine has become 
a much more complex, challenging, and chaotic 
place than it was when they received their 
medical diplomas. 

The Anatomy of a Revolution 

"Many people who come back for their 25th 
reunion could say there has been a revolution 
in medicine," said opening moderator Joseph 
Bonventre, the Robert H. Ebert Professor of Medicine at 
HMS. As the first set of speakers made clear, new tech- 
nology — especially the methods of molecular biology — 
has redefined the nature of disease and treatment. 
"Cancer therapy is being guided more and more by the 
genetics of the cancer cell," said Ilan Kirsch, chair of the 
genetics department at the National Cancer Institute. 
Other areas of research, such as xenotransplanta 
tion, are benefiting from the molecular revolution. 



"Twenty-five years 

ago could we have 

predicted where we 

are today?" asks 

Deborah German. 

"My answer 

is no." 

Hugh Auchincloss, Jr., professor of surgery at HMS, 
described how cells from genetically modified animals 
are being transplanted into humans with diabetes, 
stroke, and Parkinsons disease in early clinical trials. 
Transplanting whole organs has been less successful so 
far due to problems with rejection, he said. 

The explosion in molecular biology is leading not only 
to new therapies for patients, but also to new challenges 
for medical students and physicians, said Phyllis Gardner, 
senior associate dean for education and student affairs at 
Stanford University School of Medicine. "We're facing a 
tsunami of information, and it has all come about 
because of the digital revolution," she said. To stem the 
tide, new digitally based learning tools are being devel 
oped that integrate information. Simulation-based com- 
puter programs are teaching skills such as interview- 
ing patients, introducing a catheter, and prepar- 
ing for surgery. 

Medical costs are also being cut with the 
aid of computers, said Deborah German, 
senior associate dean for medical education 
at Vanderbilt University School of Medicine. 
She described a computer based drug order- 
ing program implemented at her hospital that 
shows how much a particular drug costs and 
what other drugs are available. The program has saved 
her hospital $6 million. 

Yet technology — particularly the use of computers 
to monitor physician productivit) — is making life more 
difficult for many physicians, added Hope Druckman, a 
physician at Virginia Mason Medical Center in Seattle. 
"I must say that most days I feel like Lucy in the choco- 
late factory," she said, referring to a classic episode of 
the television show "I Love Lucy" in which chaos 

// We're facing a tsunami of information, and it has all 




ias transformed the world of medicine by MlSIA LANDAU 

erupts as Lucy and Ethel try to decorate bits of candy 
whizzing by on a conveyor belt. "We're doing 17.5- 
minute visits with our patients, but instead of 20 visits 
like we used to do, we're doing 30," she said. "I think 
we're really in a crisis in primary care." 

The Politics of Illness 

Taking a more global view, David Cohen, a former 
director at the Office of AIDS Research at the National 

come a 

Institutes of Health, described how the AIDS crisis is 
threatening the balance of world health. "Twenty-two 
million individuals have died from HIV so far," he said. 
Most of these deaths occurred in sub-Saharan Africa 
and South and Southeast Asia. Cohen called on the 
government to take a greater leadership role in devel 
oping a vaccine against the scourge, just as it did in the 
1950s to control polio. 

The AIDS epidemic is just one of many threats to 
world health, and by implication, the health of this 
country, said Nils Daulaire, president and chief execu- 
tive officer of the Global Health Council "We all 
now paddle in a single microbial sea," he said. The 
resurgence of tuberculosis and other infectious dis- 
eases affects not just our health, but also our national 
security, he added. 

Take southern Africa as an example. Fifty percent of 
all adults in the region could die of AIDS, Daulaire 
said, leaving a generation without adult supervision. 
Countries would be forced to recruit ever younger sol- 
diers. "Imagine a continent with 40 million child sol- 
diers," he said. Given current birth rates, 80 percent of 
the world's adults will have grown up in developing 
countries by 2050. Thirty percent of these will have 
been malnourished and could suffer from cognitive 

Many people say that addressing problems such as 
these is a hopeless task, Daulaire continued. But, in fact, 
improvements in medical technology are making the task 
doable. "Everybody here has a very important role to 
play" he added. "It's the fundamental reason we became 
physicians in the first place." ■ 

Misia Landau is senior science writer for Focus. 

of the digital revolution. #/ 


Reunion Re 

eunion Reports 




Alfred Pope '41 The 60th (and last) 
formal reunion of the Class of 1941 took 
place during Alumni Week. Eleven of the 
50 or so surviving members of the class 
attended all or part of the reunion events. 

Class members and guests convened on 
Friday morning for the Alumni Day sym- 
posium, in which Dean Joseph Martin pro- 
vided a comprehensive review of impres- 
sive expansions in both HMS academic 
programs and physical facilities. After 
lunch, we had opportunities to attend a 
symposium on the HMS-MIT teaching 
program and to participate in guided tours 
of the recently renovated Countway 
Library of Medicine. 

The Class of 1941 members and their 
guests reconvened Friday evening for din- 
ner in the Benjamin Waterhouse Room in 
Gordon Hall. We were privileged to be 
addressed by classmate Carl Taylor, emeri- 
tus (but still active) professor of interna- 
tional health at Johns Hopkins University 
and widely known contributor to 
improved public health and medical prac 
tice throughout the developing world. Carl 
spoke to us about his efforts in Nepal, 
accompanied by a series of superb slides of 
that country's beautiful landscapes and 
interesting people. It was a fascinating and 
moving ending for the day, and we are all 
proud to have Carl as a classmate. 

A contrasting, but also gracious and 
rewarding, final reunion event was an ele- 
gant private reception and luncheon at 
The Country Club in Chestnut Hill on 
Saturday. This provided an opportunity 
for camaraderie, reminiscing, and sharing 
of experiences, as well as uninhibited dis- 
cussion of the state of medicine and the 
world. We parted with a seemingly unan- 
imous feeling that the reunion had been 
quite special and a most informative, 
enjoyable, and heart warming occasion. 
We all regret the loss of so many of our 
classmates and the inability of many oth- 
ers to attend our final reunion. Finally, we 
are grateful to all those at HMS who orga- 
nized the reunion, particularly Jean Hurd, 
who played a crucial role. ■ 


nion Repor 

George S. Richardson '46 As 

always, it was a pleasure to chat with old 
friends and their spouses in the perfect 
weather that Harvard commencements 
boast about but don't always deliver. 
Our class picture shows 27 classmates 
and 13 spouses, but peak attendance at 
our observances was 56, including two 
widows and some daughters and sons. 
Attendance built up as time went on, 
from the Thursday reception at Vander- 
bilt Hall to the Friday dinner at The 
Country Club and the Saturday clam- 
bake at the Richardsons' home. 

In the Quadrangle, a highlight was 
the tour of the newly redesigned 
Countway Library of Medicine, whose 
lowliest innards have been replaced by 
magnificent rooms dedicated to dis- 
coverers and teachers we have known 
and loved. Computer teaching and 
computer capability were on display 
and were impressive. It was amusing, 
too, as HMS '46ers bumped into each 
other unexpectedly, passing on sepa 
rate tours. 

At The Country Club, attendees were 
challenged to perform as after-dinner 
speakers and the response that built up 
was, as one of us put it, "Magical!" Mil- 
ton Hamolsky enabled us to relive our 
years when close-order drill filled what 
is now the grassy roof of the Quadrangle 
parking building, and the most seri- 
ous — and ineffectual — order from our 
commander was to "Leave my WAC 
alone! In the first place, she's a woman, 
and in the second place, she (a sergeant) 
ranks hell out of all of you." 

The evening was not all lighter-than 
air, of course — appropriately enough, 
analyst Art Ourieff, always listening with 
the third ear, reminded us of the sadness 
and loss that goes with our years. 

Temptation came my way when, for 
a time, Don Thomas's jacket was left 
behind with its unobtrusive Nobel 
Prize button in place. What an oppor- 
tunity to swagger around for a bit 
among the ignorant! Oh, well. Even 
some of us elderly succumb to what Art 
Ourieff might call "infantile fantasies." ■ 



eunion Repor 



Gerald Foster '5 1 Jean Dawson, quot 
ing Dorothy Murphy, wrote in our year- 
book in 1951 that we were "the biggest 
bunch of characters ever to arrive here." 
Well, 50 of these characters, along with 
an assortment of spouses, friends, and 
family members, came to this special 
50th reunion. 

Distant travelers included Woodbury 
(Puerto Rico); Bikoff, Haynes, Karlen, 
McDuffie, Norris, Olson, and Peebles 
(Florida); Chapman, Dreyfus, Fahey, 
and Gordon (California); Dawson-Ross 
(Louisiana); Tuttle (Georgia); Fernald and 
Tetirick (Ohio); Richardson (Virginia); 
Zukoski (Arizona); Danforth (Missouri); 
Toll (Colorado); Lohnes (South Carolina); 
Frothingham (North Carolina); and 
Kleaveland, Skinner, and Man Wingate 
(Washington). Since the reunion, we 
learned of the death ot Henry Wheeler on 
October 12. Henry was a lively participant 
at our reunion and he will be missed. Our 
thoughts and condolences go out to Isabel 
and the family. 

We were pleased that Selma Damon, 
Pat Geschwind, Joan Galdston, and Joan 
Oates joined us for some of the festivities. 

Ruth and Jerry Foster hosted a recep- 
tion and dinner at their home in Belmont 
on Thursday. We were honored to have 
Deans Martin and Federman join us at 
that time. .Alumni Day had an interesting 

program, and Tor Richter and Bill Dan- 
forth, who did a terrific job chairing the 
Reunion Gift Committee, presented to 
the dean a check establishing the Class of 
1951 Scholarship Fund. 

Friday evening we took over the main 
dining room of Maison Robert, with 
cocktails outside and an elegant dinner. 
We were treated to Ned Dreyfus' s record 
ing of "The Chancre Laden Maiden" and 
"The Girl with Von Recklinghausen's Dis- 
ease," and learned the true story about 
Murray Strober and the "ciliary ganglion 
caper" inflicted on Vince DiRaimondo. 
Mostly we enjoyed each other's company 
in a wonderfully relaxed setting. Satur 
day afternoon found us sailing around 
Boston Harbor aboard the Seaport Belle 
and enjoying a lobster and clam bake. We 
were blessed with perfect weather, fond 
memories, and an opportunity to recon- 
nect with classmates and friends. 

Many thanks to the locals (especially 
my wife, Ruth) for orchestrating a mar- 
velous reunion. And a special thanks to 
Clem Hiebert for making buttons out of 
our graduation pictures. How young we 
looked when we started this exciting 
career. As a matter of fact, we still look 
pretty good. And we can be proud of our 
contributions over the past 50 years in 
patient care, scientific research, and 
medical education. ■ 

Reunion Reports 

Reunion Reports 


Richard O'Hara '56 Members of the 
Class of 1956 thoroughly enjoyed our 
45th reunion — a marvelous opportuni- 
ty to renew old friendships and enjoy 
each other's company. 

Approximately 93 people attended 
our class dinner at the St. Botolph Club, 
and it was a great success. One member 
of the class, Paul Altrocchi, gave a brief 
address on his new book, Most Greatly 
Lived: A Biographical Novel of Edward de 
Verc, Seventeenth Earl of Oxford, Whose 
Pen Name Was William Shakespeare — 
not William Shaksper of Stratford, 
Altrocchi contends. 

The next day we adjourned to the 
Mount Washington Hotel in Bretton 
Woods, New Hampshire, for two days 
of pure fun, food, and enjoyment. It was 
an unmitigated success. 

Plans are in place for our 50th, and all 
have promised to be there! A musical par 
ody of some sort is in the planning stages. 

We wholeheartedly enjoyed the 45th 
and strongly urge all reunion classes to 
make the effort necessary to enjoy the 
opportunity that these reunions present. 

Our fondest memories of HMS are 
inexorably intertwined with the lasting 
friendships made there. ■ 





Clarence (Ren) Zimmerman '61 On 

a balmy spring evening, ]unc 7, nearly 80 
members of the Class of 1961 (including 
spouses and a smattering of significant 
others), convened at my Brookline home- 
to start the 40th reunion weekend. I 
was not there. Absented by an uniore 
seen and unavoidable conflict with my 
daughter's high school graduation, I left 
the whole thing in the lap of my wife, 
Peg, and the rarely seen John Dowling. 
From what I learned later, they did a 
marvelous job. John and his wife, Judy, 
have just retired as co masters of Har 
vard's Leverett House, so were used to 
unruly mobs and crowd-control issues. 
A somewhat smaller but no less 
enthusiastic contingent made up my 
first viewing of the class during the 
Reunion Week seminars and speeches 
on Friday. At one point, proper note was 
made of the extraordinary generosity of 
Yeu-Tsu Margaret Lee. A vignette about 
her gift appears on the inside back cover 
of the spring issue of the Harvard Medical 
Alumni Bulletin. 

By evening, New England's fickle 
weather continued to smile upon a 
delightfully packed cocktails and-dinner 
party at The Country Club. The irre- 
pressible Peter Liebert photographed 
everyone, Peter Randolph and Bob Lein- 
bach serenaded us after dinner from the 
piano, and Ron Grimm, who organized 
the spectacularly successful 40th 
Reunion Fund, regaled us with tales of 
New Guinea, flashing that peculiar surgi 
cal sensibility that permits one to speak 
of body parts while sipping a demitasse. 

On Sunday we closed the weekend 
with a buffet at MIT's lovely country 
estate, Endicott House. The reunion co- 
chairs. Buck Frederick and Ten ley 
Albright, both spoke, and both deserve 
the thanks of their classmates for their 
efforts. But the really fun stuff about the 
reunion won't make it into print — the 
one-on-one renewal of old friendships, 
the rememberings of four shared years in 
the crucible of Harvard Medical School, 
and the reaffirmation of a simple fact: We 
are a great class! ■ 






Jay H. Kaufman '66 The great HMS 
Class of 1966 celebrated its 35th 
reunion at the Ocean Edge Resort in 
Brewster, Massachusetts. The weekend 
began Thursday evening, as usual, with 
a cocktail party at the home of Jenzie 
and Bill Shipley in Chestnut Hill. The 
next day we were able to hear two of 
our own, Charlie Hatem and Bob 
Fletcher, talk about physician renewal 
to the assembled alumni. Friday, we 
gathered at the Ocean Edge Resort and, 
as per our tradition, each member of 
the class, and some of the spouses, 
spoke of how the past five years had 
gone, and what they planned for the 
future. Among them, David Gilmour 
spoke of his retirement and his career 
afterward, and Paul Torop talked of the 
mental health carve-out that he had 
created. Joel Friedman was, as usual, 
indefatigably upbeat about the future 
of medicine. 

Bob Owen, class photographer, 
brought his album of recent and past pic 
tures, and Tom Gettelfinger distributed 
news summaries to bring us up to date 
on the events of 1962-66, which we had 
missed 35 years ago. During the day on 

Saturday, the class biked, ran, and played 
lots of tennis. Distinguishing themselves 
at the latter sport were Scott Nelson, 
Richard Hannah, Carol and Joel Fried- 
man, and the Shipleys. One lonely class- 
mate even golfed. Jack Schott was the 
athletic star, instructing many of his 
classmates on the fine art of competitive 
croquet. Bruce Cutler and Larry Beck, 
both of whom were all- American swim- 
mers in college, swam to Pro\*incetown 
and back. 

On Saturday night, our ranks swelled 
by classmates who could not make it the 
first night, we had a great clambake at 
the hotel. Bob Binder represented our 
dental classmates, and Carol (Mrs. Bob) 
Greenes even sang a few bars from our 
Second Year Show. After dinner, Father 
Ned Cassem was seen watching the 
Stanley Cup finals and offering support- 
ive comments for the Avalanche in the 
highly moral way that we all remember. 
By Sunday morning, the tired group 
gathered for a last breakfast together, 
and began to plan for our 40th reunion. 
The class spouses, however, vetoed 
George Hardman's suggestion that this 
take place in Iceland. ■ 






Alexandra Harrison '71 The first 
event of the 30th reunion of the Class of 
1971 was dinner at the Harvard Faculty 
Club. It was such a pleasure to greet old 
friends. The Faculty Club is more ele- 
gant than it was in our days, and the 
food was excellent. It was hard to stop 
talking and eat, though, since we all had 
so much catching up to do. 

Mark Goldman distributed the 
results of the confidential question 
naire, offering a fascinating picture of 
the class. Among the most interesting 
facts: 57 percent of the respondents live 
in the suburbs; 71 percent have been 
married once, most for about 25 years; 
75 percent are in excellent health; most 
respondents arc roughly the same 
weight as they were in med school; most 
are both prolessionally and personally 
happy; more than half consider them 
selves politically liberal; two thirds ol 
the respondents would go into medi 
cine again; and only one-third are 
encouraging their children to go into 
medicine. Times have changed. 

It was sad to mark the death of our 
classmates Phil Compeau, John Mantos, 
and Gene McDonald. On a humorous 
note, one of the people listed as 
deceased wrote back to Mark. George 
Feldman wrote: "Dear Mark, Not to nit 
pick, but technically I'm not dead — just 
residing in New Jersey. Warmly, 
George." The error was corrected by 
notification to all classmates. 

Saturday we were lucky enough to 
repeat an old tradition of a clambake at 
the Donaldsons' in Lincoln. Sixty three 
members of the class and family mem 
bers enjoyed Craig and Jennifer's extra- 
ordinary hospitality. It was a hot day, 
and a tent was set up on the rolling 
green lawn of the backyard. We contin- 
ued our conversations from the night 
before, sitting on the grass or in the 
shade of the tent. Jim Goodwin told a 
story of HMS roommates putting inno 
cent lobsters into a pot of cold water 
and turning on the heat. Joel Green- 
berger played us beautiful jazz on his 
trumpet. Dennis Landis brought slides 
of our Class Day and class pic- 
nics so that we could recognize 
the truthfulness of our answers 
to the questionnaire. We all 
look the same, minus a little 
hair or color in the hair. 

The success of the 30th 
reunion ol the Class of L971 
was due in large part to the 
Reunion Committee — espe- 
cially Co- Chair Ann Stark, 
Treasurer Frank Berson, and 
Secretary Mark Goldman, and 
all the committee members: 
Rob Reart, Craig Donaldson, 
Harvey Fineberg, Skip Fuller, 
Fred Jones, Cindy and Rill Ket- 
tyle, Stu Orkin, Jeremy Ruskin, 
and Joel Schwartz. Special 
thanks also to all the people in 
the Alumni Office for their 
generous assistance from the 
beginning of the planning to 
the happy ending. 

It was hard to say goodbye 
after just reconnecting. We all 
resolved to keep in touch and 
not wait for five years. We 
missed those of you who didn't 
make it this time. Please come to 
our 35th ■ 



Reunion Reports 



Reunion Reports 


Hans T. Aretz '76 About 75 members 
of the Class of 1976 gathered during the 
two days of our 25th reunion. "Twenty- 
five years! How time flies!" was an 
often-heard refrain. Well over 100 class- 
mates had submitted entries and pic- 
tures for the reunion book, which made 
for quite interesting, moving, and often 
inspiring reading. Many thanks again to 
everybody who contributed to this 
effort — it provided memorable snap- 
shots of the lives of a diverse group of 
people who, despite professional and 
personal adversities and setbacks, still 
seem to share one thing: a love, or at 
least respect, for the field of medicine. 
Thursday's symposium, given by mem- 
bers of the class, provided a glimpse 
into some of our varied interests and 
career paths. Many thanks for the spe- 
cial efforts of the speakers. 

The symposium began with scientif- 
ic presentations covering subjects 
ranging from the genetics of cancer to 
invasive radiology, followed by talks on 

medical education, since several mem- 
bers of the class hold leadership posi- 
tions in this field. The afternoon began 
with a global perspective on medicine 
covering such subjects as the devastat- 
ing global AIDS crisis, the pathogene- 
sis of epidemics, and global health as a 
national security problem. 

The remainder of the day was 
reserved for more personal topics, 
allowing a glimpse into some of the 
challenges of a physician's life: being a 
woman physician and bringing up chil- 
dren; trying to maintain hope in the 
face of personal loss; and struggling to 
serve your patients in a system that 
seems to be designed to defeat those 
efforts. In addition, some very practical 
and humorous advice was offered for 
the physician as traveler. Overall, most 
of us seem happy — maybe happier than 
we were 25 years ago. A. Stone Fried- 
berg, reflecting on 60 years at HMS, 
added his perspective as he concluded 
a very successful day. 

Thursday evening was 
taken up by a reception and 
dinner in the atrium of the 
Tosteson Medical Education 
Center (nonexistent in our 
days). Daniel Federman '53 
was kind enough to join us 
and address the class, and 
Marvin Bittner added yet 
another chapter to "The 
Warning Signs." 

On Friday night, a recep- 
tion and dinner at the Bay 
Tower Room concluded the 
official program. Dale Black 
stock's husband and daugh 
ters (HMS '04 and '05) 
joined us. Dale is one of five 
classmates who have passed 
away. After dinner the class 
exchanged information, for 
the most part factual, about 
those classmates who were 
not able to come to the 
reunion. We hope you won't 
miss the next one in five 
years, so you can tell us 
what you're really doing! 
Finally, many thanks to Jean 
Hurd and Nora Nercessian 
in the Alumni Office for all 
their work. ■ 



union R 

Michael C. Payne '81 In the 20 years 
since our graduation, the Class of 1981 
has changed in outward appearance, 
professional direction, and areas of 
interest. Yet during that time, the drive, 
the determination, and the personae of 
our classmates have not varied all that 
much from the days when we sat in lec- 
tures together in Building A. 

In both the Alumni Day activities and 
the social activities that followed, we all 
had the opportunity to reunite ties — to 
the institution, to our own personal life 
histories, and to those people we called 
friends so many years ago. 

Forty-three people attended the Bay 
Tower Room dinner. Classmates and 
their significant others came together to 
dine, to talk, and to reminisce. Despite 
the 20 intervening years, we as a group 
have not changed substantially from 
when we first met each other. I was 
impressed that, in spite of the pressures 

of time, work, and family, the brilliant 
personalities that I knew 20 years ago 
still give our class the unique strength 
and insight that it has to this day. 

The luncheon at Manuel Lowcn 
haupt's house confirmed that impres 
sion. The 54 adults and 25 children who 
attended amply demonstrated that we 
have interests outside of our careers. It 
was fun watching our families interact. 
There was a Tightness about the alter 
noon that suggested that perhaps our 
particular cohort was doing better than 
could have been expected. 

Between the lobster and the roast 
chicken and a beautiful New England 
day, I would declare the 20th reunion of 
the Class of 1981 a rousing success. We 
had an opportunity to share life stories 
and to teach each other once again that, 
despite distance and time, we are still 
members of an exceptional group of 
people. ■ 



Reunion Reports 


Reunion Reports 

Mark S. Hughes '86 The 15th 
reunion of the Class of 1986 was a great 
success, and the 15th reunion book 
was filled with interesting information 
about our increasingly busy lives. 

On Friday evening, we had a fabulous 
social hour and dinner at the Harvard 
Club with more than 25 of us attending. 
Classmates from Atlanta, Virginia, Illi- 
nois, New York, Maryland, Washington, 
DC, and the Greater Boston area enjoyed 
the meal and company. We did have a 
few sobering moments, though, when 
we compared cholesterol levels and dis- 
cussed which statins we were taking. 

On Saturday, Mark and Kim Girard 
hosted an extraordinary picnic at their 
beautiful home in Marblehead. More than 
30 adults and 30 children attended the 
lobster feast, and the weather cooperated 
beautifully Mark and Kim get special 
credit for renting a "Moon Bounce" and 
having a shovel and bucket for each child 
to play with on the rocky beach. Many 
classmates toured Marblehead after the 
picnic and had a most enjoyable evening. 

We look forward to the 20th reunion 
and better lipid levels! ■ 



Mary Barton '91 On the whole we 
feel that we all look just the same. Well, 
close. In any case, the Class of 1991 had a 
spectacular tenth reunion, and lots to 
smile about — and, of course, all of us 
look younger when we're smiling. 

Having traveled from near and far to 
Boston, the assembled members of the 
Class of 1991, along with their spouses, 
significant others, and guests, com- 
menced the revelries with dinner at 
The Elephant Walk on Friday night. 
We enjoyed Cambodian cuisine and the 
hum of ceiling fans as we shared with 
one another our tales of success and 
woe in office practice, hospital attend- 
ing, and child care, and reported news 
of other class members who could not 
be there. Forty-three of us attended. 
After dinner we paused in remem 
brance of three class members who are 
no longer with us: Bemy Jelin, Reza 
Gandjei, and Dave Godley. Beth 
Biegelsen reminded us to cherish the 
days that we have. 

On Saturday, under glorious skies, 
we communed with nature at a picnic 

at Larz Anderson Park. More than 50 
adults and several gaggles of children 
came together to eat barbecue and corn 
on the cob, and to listen for the bells of 
the ice cream truck in the parking lot. 
We were entertained by the antics of 
the younger set. While we in the class 
are pretty closely grouped in age, our 
children range from the young adult 
(Beth Rider's children) to the preco- 
cious pre-adolescent (Chris Peckins 
and Susan Abookire's daughter Sylvie) 
to a number of wee infants such as those 
arriving with Jonathan Bogan, Gaby 
Otterman, Monika Woods, and myself. 
Traveling from the left coast for the 
reunion, Peter Sokolove and Sally 
Holtzman modeled relaxation for the 
assemblage — even the New Englanders 
got the hang of it. 

A bow of thanks to the Reunion 
Committee: Zoher Ghogawala, Bill 
Hahn, Sara Bolton, Reisa Sperling, and 
Beth Biegelsen, and our indefatigable 
comrade in the Alumni Office, Jean 
Hurd, for laying the groundwork for 
such a successful reunion. ■ 



union Re 

Reunion Repo 



Jeffrey Schnipper '96 A small but 
enthusiastic crowd showed up for the 
fifth year reunion weekend. Most of the 
folks were from the Boston area, but a 
few managed to come all the way from 
Philly, South Carolina, Michigan, and 
even California. 

The festivities started Friday night at 
the Brown Sugar Cafe on Common 
wealth Avenue, where we had excellent 
Thai food (with lots of appetizers!). Par 
ticipants included Melinda Fan; Ann 
(Bramlage) Heerens and her husband, 
Hans; Deborah Hoffer and her husband, 
David; Rajani LaRocca and her hus- 
band, Lou; Jeff Schnipper and his wife, 
Allison; Larry Sanders (who had to run 
off early to get ready for the radiology 
boards that weekend); Antonia (Apple) 
Stephen; and Marcia Zuckcrman. Ann's 
son Mark, five months old, was at Raj's 
house with Raj's son [oseph (oh yeah, 
and a babysitter, too). 

Saturday night we regrouped for 
cocktails and an elegant dinner at the 
Bay Tower Room in downtown Boston. 
New laces included Michelle Barr and 
her husband, Brian O'Connor; Larry 
Bloch; Dave Brown; Lis Hagen; Pam 
Horn; Elbert Huan>' and his liancee. 

Tina Louie; and Dave Munoz and his 
wife, Cynthia. 

On Sunday, we had perfect weather 
for a mellow picnic at Larz Anderson 
Park. Helping to make a dent in the 
pulled pork and watermelon were Ivana 
Kim and her husband, Bill Han; Yngvild 
Olsen, Josh Sharfstein, and their son, 
Sam; Christoph Westphal; and a few 
folks from earlier events (this time, 
Michelle brought her mom). Making up 
for their tardiness with their arrival 
were Tom Gaziano, his wile, Andrea 
Reilly, and their newborn (really new- 
born) son, Dominick. 

The various events gave everyone a 
chance to catch up, reminisce about the 
good old days in the MEC, and spread 
vicious rumors about those who weren't 
there (just kidding). It was also nice to 
see our classmates finding the time to 
have real lives and to sample the varied 
paths our careers have taken since meel 
school (including several classmates 
practicing medicine outside ol the ivory 
tower and the occasional businessperson 
or two). We also vowed to keep in touch 
and to do a better job of rounding every- 
body up for the tenth. 1 hope that, by 
then, we won't all still he in residency. ■ 





Robert J. White 

1953 dedicated an exhibit titled 
"The Universe in the Head" 
at the Stiftung Deutsches 
Hygiene- Museum in Dresden, 
Germany, in the fall of 2000. 
A portion of White's neuro- 
scientific laboratory had been 
re-created within the exhibit. 
In April 2001, White was 
invited to return to Germany, 
where the exhibit was being 
shown at the Landesmuseum 
fur Technik und Arbeit in 
Mannheim. While he was 
in Mannheim, a book titled 
Mcincn Kopf auf deincn Hals, 
which deals with his work 
and concepts in neuroscience, 
had its debut. 

Arthur S. McFee 

1957 "I retired as professor and 
chief of general surgery on 
August 31, 2001, after 34 years 
at the University of Texas 
Health Science Center at San 
Antonio, and six years as 
chief. It has been a fascinating 
three-decade experience par- 
ticipating in the development 
of a new medical school from 
its inception. I became profes- 
sor emeritus upon retire- 
ment. On a lighter note, Eliz- 
abeth and Richard Wagman 
spent five days with us in 
July at our home in Santa Fe, 
New Mexico, to sample some 
opera, some things South- 
western, and some things 
Native American." 

Tucian T eape 

1959 was made an honorary fellow 
of the Royal College of Physi- 
cians and Surgeons of Canada 
for his efforts to advance 
patient safety and prevent 
iatrogenic injury. Leape is 
adjunct professor of health 
policy at the Harvard School 
of Public Health. 

Irwin Rosenberg 

joined Tufts University's 
most distinguished faculty in 
October, when he was named 
University Professor. This 
honor has been awarded to 
only three other Tufts faculty 
members before him. Rosen- 
berg is dean of Tufts Univer- 
sity's School of Nutrition Sci- 
ence and Policy and the Jean 
Mayer Professor of Nutrition. 
He served as director of the 
Jean Mayer U.S. Department 
of Agriculture Human 
Nutrition Research Center 
on Aging for 15 years. 

Irene Fox Briggin 

1963 "During our recent visit to 
Bangkok, the events of Sep- 
tember 11 occurred. My hus- 
band and I were extremely 
grateful that Peck and Yong 
Uahwatanasakul lived there 
and were of enormous sup- 
port to us for the week that 
elapsed before we could 
return to the States. They 
imited us to their lovely 
home, took us out for dinners, 
and drove us to interesting 
sites in Bangkok, all of which 
were welcome distractions 
from watching replays of the 
collapsing towers on CNN. 
Yong's generosity is also 
reflected in his continued 
practice of medicine, which 

is largely pro bono. We had 
some interesting discussions 
comparing the state of medi- 
cine in Thailand to that in the 
U.S. Peck's warmth and gra- 
ciousness were expressed in 
so many ways, including tak- 
ing us on a wonderful day trip 
while Yong worked. Yong has 
asked me to encourage any 
member of the class who is in 
his part of the world to visit 
him. If you do, you are in for 
a warm welcome and a most 
interesting experience." 

lorrin M. Koran 

1 966 was given the Excellence in 
Teaching award by the 2001 
graduating class of psychi- 
atric residents at Stanford 
University Medical Center, 
where he is professor of psy- 
chiatry. In addition, his book 
Obsessive-Compulsive and Related 
Disorders in Adults: A Comprehen- 
sive Clinical Guide, has entered 
its third printing. 

WReid Pitts, J r. 

1967 "I know of no casualties from 
the World Trade Center 
attack who attended HMS. 
Unfortunately there were very 
few casualties that we could 
treat, as over 95 percent of the 
people in the towers at the 
time of the collapse died. On 
a brighter note, with the 
encouragement of my family 
(Marguerite, Will, and 
Bradley) and one HMS class- 
mate, I have been off all 
alcohol for ten months. I feel 
great! It is amazing how well 
you feel when you stop hitting 
your head with a hammer. 
Bradley (MIT V0) is back at 
school for a master's in aero- 
astro engineering before going 
on to architecture school to be 
a residential architect with a 
subspecialty in architecture 



n ts w i 

$. P I I 

i 1 1 a. 

"' S "» f 

rs o G • 

— — n a.